目的 探讨基于医院-社区-家庭的营养管理方案对头颈部肿瘤放化疗患者营养状况的影响。 方法 选择 2022 年 2 月至 2023 年 3 月于江苏省人民医院接受放化疗的 150 例头颈部肿瘤患者作为研究对象,采用随机数字法将患者分为干预组 与对照组,每组患者 75 例。 对照组给予常规营养管理,干预组给予基于医院-社区-家庭的营养管理方案,干预 3 个月后使用 患者主观整体评估(PG-SGA)、营养风险筛查 2002(NRS 2002)评估两组患者营养水平,比较两组患者入院及放化疗治疗结束 后体质指数(BMI)、总蛋白、白蛋白、并发症发生率及严重程度。 结果 干预组患者放化疗治疗结束后总蛋白[(67. 62±6. 09) g / L 比(61. 75±5. 28) g / L]、白蛋白[(37. 78±4. 12) g / L 比(33. 17±3. 98) g / L]、前白蛋白[(214. 23±45. 19) g / L 比(191. 08± 42. 58) g / L]、淋巴细胞计数[(1. 13±0. 39) ×10 9 / L 比(0. 74±0. 43) ×10 9 / L]均高于对照组(P<0. 05);并发症发生率(30. 67% 比 54. 67%)及严重程度(25. 33%比 56. 67%; 5. 33%比 8. 00%)均低于对照组(P<0. 05);根据 NRS 2002 结果,干预组低营养 风险患者比例高于对照组( 86. 67%比 77. 33%, P<0. 05),高营养风险患者比例低于对照组( 13. 33%比 22. 67%,P<0. 05); PG-SGA 评分[(6. 98±5. 17)分比(7. 42±4. 63)分]及 BMI[(20. 93±2. 74) kg / m 2 比(19. 62±2. 81) kg / m 2 ]均优于对照组(P< 0. 05);干预后干预组患者每日肠内营养摄取能量高于对照组[(691. 83±264. 29) kcal 比(348. 12±153. 28)kcal,P<0. 05]。 结 论 基于医院-社区-家庭的营养管理方案对头颈部肿瘤放化疗患者有着良好干预效果,可显著改善患者营养状况及并发症严 重程度。

Objective To explore the impact of hospital - community - family - based nutritional management program on the nutritional status of head and neck cancer radiotherapy patients. Method 150 head and neck cancer patients who received radiotherapy in Jiangsu Provincial People's Hospital from February 2022 to March 2023 were selected as the study subjects and the patients were divided into the intervention group and the control group using the random number method with 75 patients in each group. The control group was given routine nutritional management and the intervention group was given a hospital-community-family-based nutritional management program and three months after the intervention the patients were evaluated using the patient-generated subjective global assessment PG-SGA nutritional risk screening NRS 2002 to assess the nutritional level of the two groups of patients and t-test / χ 2 test was used to compare the BMI total protein albumin complication rate and severity of the two groups of patients after admission to the hospital and the end of radiotherapy treatment. Result Total protein 67. 62±6. 09 g / L vs 61. 75±5. 28 g / L albumin 37. 78±4. 12 g / L vs 33. 17±3. 98 g / L prealbumin 214. 23±45. 19 g / L vs 191. 08±42. 58 g / L and lymphocyte count 1. 13± 0. 39 × 10 9 / L vs 0. 74± 0. 43 × 10 9 / L were higher than those in the control group P < 0. 05 the complication rate 30. 67% vs 54. 67% and severity 25. 33% vs 56. 67% 5. 33% vs 8. 00% were lower than those in the control group P < 0. 05 and the proportion of patients with low nutritional risk in the intervention group was higher than that in the control group 86. 67% vs 77. 33% P < 0. 05 and the proportion of patients with high nutritional risk was lower than that of the control group 13. 33% vs 22. 67% P < 0. 05 PG-SGA score 6. 98 ± 5. 17 points vs 7. 42 ± 4. 63 points and BMI 20. 93 ± 2. 74 kg / m 2 vs 19. 62 ± 2. 81 kg / m 2 were both better than that of the control group P<0. 05 . Daily energy intake for enteral nutrition was higher in the intervention group than in the control group after the intervention 691. 83±264. 29 kcal vs 348. 12±153. 28 kcal P< 0. 05 . Conclusion The hospital-community-family-based nutritional management program has a good intervention effect on patients with head and neck cancer radiotherapy which can significantly improve the nutritional status and severity of complications.