頭頸部癌患進食及營養狀況之探討
Eating and Nutrition States in Patients With Head and Neck Cancers
中文摘要 頭頸部癌症可施行手術、放射線及化學治療，療程中可單獨或合併進行治療方式 （徐，2001；Alison et al., 2002）。多種治療的副作用中，又以口腔黏膜改變最為 困擾，對病人的生理、心理、社會都會造成莫大的影響（Alison, 2002）。國內口 腔癌病人以 40~60 歲之間最多，但 30~39 歲發病個案也逐年上升（林，2002）； 此類病人以青壯年最具生產力的人口居多，病人從診斷的衝擊、經歷切片手術及 進一步放射線照射或化學治療，往往造成病人身心極大的衝擊；且若在此時罹癌 對社會、家庭都會造成莫大的衝擊及影響（林，2002）。為能確實瞭解頭頸部癌 症病人的營養狀況與實際飲食攝取情形及影響進食、吞嚥的相關因素或機能改變 的因素探討，故本橫斷式研究旨在探討台北某醫學中心整形外科病房、口腔外科 病房、耳鼻喉科病房、血液腫瘤科病房或門診頭頸部癌症病人的進食困難與營養 狀況之相關問題。共收集 100 位個案，資料內容包括病人基本資料、進食困難程 度評估、身體質量指數（body mass index; BMI）、身體功能狀態（Karnofsky＇s performance status; KPS）及迷你營養評估（Mini-Nutritional Assessment; MNA）、 生化值（血清白蛋白及血紅素）。資料分析以描述性統計、單因子變異數分析（one way ANOVA）、皮爾森相關（Pearson＇s correlation）、逐步回歸（stepwise regression）。研究結果發現：（一）研究對象進食困難程度落在輕度或中度影響 吃或吞東西。且有 85％的病人顯示他們在過去的三個月因食慾、咀嚼及吞嚥困 難以致影響進食量。（二）在 MNA 總分方面（0~30 分），本研究對象平均值為 17.7±4.00；超過 50%的個案，依照其營養程度分類上，潛在營養不良者（MNA17~23.5）佔 53%為最高，營養不良者（MNA<17）佔 5%。（三）MNA 總分愈低，進食困難程度得分愈高，營養狀況愈差。但無法把食物咬爛、上下顎 牙齒無法咬合、吃東西時容易嗆到、食物無法吞嚥、口腔內有疤痕吃東西困難、 聞不出食物味道，這六項進食困難程度為最高，且與 MNA 營養不良指標總分有 顯著的相關性。（四）進食困難程度、BMI、KPS、血清白蛋白值、血紅素值、 治療方式、合併其他慢性病及住院與否，均達統計上相關，能有效預測以 MNA 總分作為評估的營養狀況（R?=52.3%）。本研究結果提出改善頭頸部癌症病人進 食困難的需求與其營養狀況是一個急迫但長遠的議題。期許建立臺灣頭頸部癌症 病人進食與吞嚥困難及營養評估之相關資料，透過問題解決及相關因素之探討， 來改善頭頸部癌症病人因疾病、治療所引發的各種需求或症狀護理及營養狀況， 進而提昇頭頸部癌症病人的生活品質與尊嚴；更期待跨科部的參予，讓頭頸部癌 症病人能得到更完善之醫療品質的照護。 英文摘要
The purposes of the cross-sectional study were to delineate the nutritional status and the real food intake and identify the factors influencing food intake and swallowing abilities in head and neck cancer patients. Patients were recruited from a medical center in Taipei. One hundred head and neck cancers were recruited. We assessed information related to patients’ background characters, degrees of eating difficulties, body mass index (BMI), performance status (measured by Karnofsky’s performance status, KPS), nutritional status (measured by mini-nutritional assessment, MNA), and biochemical profiles (serum albumin and hemoglobin). Data were analyzed by descriptive statistics, one way ANOVA, Pearson's regression, and stepwise regression. Several important results were found. First, most patients with eating difficulties had mild to moderate eating or swallowing disabilities. Second, majority of patients were in “at risk of malnourished” status (17.7±4.00) and 5% of patients were malnourished. Third, the 6 most stressful eating problems were: (1) not being able to completely chew up the food, (2) unfitting of upper and lower jaws during chewing, (3) easy to choke while eating, (4) not able to swallow, (5) scars in the mouth cavity, and (6) loss of smelling sense. Patients who had severer level of the above mentioned problems had more severe malnutrition status. Fourth, higher degree of eating difficulty and lower BMI, KPS, serum albumin, hemoglobin can
significantly predict the level of malnutrition (R2=52.3%). The results strongly
suggest the importance of improving patients eating and swallowing problems in head and neck cancer patients to further enhance patients’ nutrition status.
