肝癌術後病人營養狀況與其相關因素探討
Nutrition Status and Related Factors in Post-Operation Patients With Hepatocellular Carcinoma
中文摘要
近年來肝癌為癌症死亡原因首位，但是癌症病人在治療期間常因腸胃道副作用
而影響進食，家屬及病人本身會因特殊理由而產生飲食禁忌。因此 了探討肝癌爲
病人營養狀況與病人基本因素、疾病與治療相關因素、心理困擾因素、肝癌病人 或家屬準備飲食的困擾及飲食行為而進行研究。
本研究採橫斷式描述性相關設計，針對探討主題採用基本資料表、迷你營養評估 表（Mini Nutrition Assessment, MNA）、症狀嚴重度量表、醫院焦慮憂鬱量表及 飲食量表等結構式問卷，以自填或問答方式收集資料。以台北地區某醫學中心門 診肝癌病人（或家屬）為對象，以立意取樣方式選取符合選樣條件之個案，共
選取88 位個案，將所得資料進行統計分析，以描述性統計包含次數分配、百分
比、平均值、標準差；推論性統計包含皮爾森積差相關和單因子變異數分析。
結果發現，病人營養良好（MNA>24）為 61.4%，潛在營養不良（MNA 17- 23.5）與營養不良（MNA<17）為 38.6%。整體症狀嚴重程度和病人的營養狀況
呈現負相關，顯示症狀程度愈嚴重則營養狀況愈差；整體症狀嚴重程度與MNA
總分呈負相關的前五項依序為為噁心、沒有食慾、便祕、早飽/吃幾口就飽了與疼 痛。病人的焦慮、憂鬱與病人營養狀況在統計上皆有顯著負相關，顯示焦慮、憂 鬱分數愈高營養狀況愈差；以單因子變異數分析進行統計分析，並做Scheffe’s 事後檢定發現，在憂鬱方面個案與疑似個案、非個案兩組有統計上顯著差異，憂 鬱個案的營養狀況比其他兩組差。飲食困擾與飲食禁忌皆和病人營養狀況呈現負 相關，顯示飲食困擾程度愈高和飲食禁忌項目愈多則病人營養狀況愈差。
針對研究結果對護理臨床實務、護理教育及護理研究提出具體建議，並提供臨床 發展介入措施的依據，以作為臨床從業人員提供肝癌病人及家屬健康照護的指 引及參考。
英文摘要
Title of thesis: Nutritional Status and Related Factors in Post-Operative Patients with Hepatocellular Carcinoma
Institution: Graduate Institute of Nursing, Taipei Medical University Author: Min-Jen Chuang, RN, MSN
Thesis directed by: Pei-Shan Tsai, RN, Ph. D., Associate Professor and Yeur-Hur Lai, RN, Ph. D., Professor
The incidence of liver cancer in Taiwan has been increasing annually. Furthermore, nutrition problems are common in hepatocellular carcinoma (HCC) patients. The
purpose of this cross-section correlational research was to explore the nutritional status and its related factors in the HCC patients in Taiwan.
Data were collected at OPD in medical center in Taipei. Instruments to collect data were several questionnaires, including Mini Nutrition Assessment(MNA), Symptom Severity Scale, Hospital Anxiety and Depression Scale, Diet Scale. Data were analyzed by descriptive statistics , ANOVA and Pearson’s correlation.
A total of 88 HCC patients were recruited. The results showed that 61.4% of these HCC patients had good nutrition status (MNA>24), 38.6% of those patients are potential (MNA 17-23.5) and poor nutrition (MNA<17). The status of whole symptoms and nutrition is negative correlation. Furthermore, physical symptoms highly correlated with MNA as their descending order of correlation coefficients were nausea, no appetite, constipation, easily fully and pain, respectively. Patients with higher anxiety or higher depression had lower nutritional status. Patients with more taboo in choosing diets had significantly lower nutritional status.
The results provide nurses the knowledge about HCC patients’ nutritional status and its related factors. In addition, this study can provide nursing care guideline to improve the nutritional status of HCC patients.
Key word: Hepatocellular carcinoma, nutritional status, depression, taboo of diet
