| [Objective]1.To observe the effect of five-step nutritional intervention on nutritional status,quality of life and adverse reactions of perioperative chemotherapy in patients with gastrointestinal tumors.2.To explore the experience and Suggestions of patients with gastrointestinal tumors receiving five-step nutritional intervention.To deeply understand the feelings of patients with gastrointestinal tumors after nutritional intervention,and to provide reference for future clinical work.[Methods]1.In the randomized controlled experimental study,PG-SGA was used to evaluate the nutritional status of patients with gastrointestinal tumors.The intervention group was given five-step nutritional intervention,and the control group was given routine nutritional intervention.Observe and compare two groups of patients in the first,three,six patients with chemotherapy regimen subjective overall assessment(the patient-generated subjective global assessment,PG-SGA),BMI(Body mass index,BMI),physical analysis,albumin(albumin,propagated)and prealbumin(prealbumin,PA),lymphocyte count(lympchocyte,LY),quality of life,if there is a difference in adverse reaction after chemotherapy.2.Follow the phenomenological research method in qualitative research.A stratified and purposeful sampling strategy was adopted to select 14 patients from the upper intervention group.The semi-structured interview was conducted to understand the patients' feelings on the five-step nutritional intervention.Nvivo11 software was used to analyze the data,and Colaizzi's 7-step method was used to sort out the interview data.[Result]1.A total of 118 patients were included.There were no statistically significant differences in pg-sga score,ALB,LY and BMI between the two groups before intervention(p>0.05),which was comparable.The cases of moderate and severe malnutrition in the two groups showed a decreasing trend in the third and sixth courses respectively,and the cases of suspected malnutrition increased slightly.After the intervention,the nutritional scores of the patients in the intervention group and the control group were statistically different(p<0.05).There were statistically significant differences in nutrition scores between the two groups at different time periods.With the increase of intervention time,PG-SGA score of patients in the two groups gradually decreased,and the score of patients in the intervention group was lower than that in the control group.The influence of intervention on the ALB level of patients in the two groups was statistically different.As time went on,the ALB level of patients in the two groups presented a downward trend,and the decline rate in the intervention group was less than that in the control group.Time and grouping factors have interactive effects on ALB.There was no statistically significant difference in lymphocyte count between the two groups,but there was statistically significant difference in time,that is,in the first,third and sixth courses of treatment,the two groups of patients showed a consistent upward trend.There was a statistical difference in PA between the two groups in the first,third and sixth courses,and there was an interaction effect between time and grouping factors,which made the intervention group always superior to the control group.There were statistically significant differences in BMI between the two groups in the first,third and sixth courses of treatment,and the intervention group was always superior to the control group.After intervention,there were statistically significant differences in body fat percentage and lean body weight percentage in the intervention group between three courses(p<0.05),and no statistically significant differences in body water percentage.In terms of patients' quality of life and functional field,time and grouping factors have statistically significant differences in scores of patients' physical,role,cognitive and social functions.The score of body function of patients in the two groups maintained a steady upward trend in three time periods.The role function of patients in the intervention group in the sixth course was slightly lower than that in the previous stage.Patients in both groups exhibited peak mood at three time points,with lower scores in the first and sixth sessions.Patients in both groups scored slightly lower on the sixth course than on the previous one.Patients in the control group scored lower on social function in the sixth session than in the previous session.Patients with liver damage,appetite loss,taste abnormalities,diarrhea,constipation,nausea and vomiting,bone marrow suppression and dry mouth and other adverse reactions.Appetite loss and nausea and vomiting were the most frequent.There were statistically significant differences in adverse reactions to chemotherapy between the two groups(p<0.05).2.Semi-structured interview was conducted on 14 patients with gastrointestinal tumors who underwent nutritional intervention for 8 months.Using Nvivo11 software,Colaizzi's 7-step analysis method was used to sort out and analyze the interview data.Four topics were summarized and extracted,including nine secondary topics:changes in lifestyle;rehabilitation of social functions;needs for complementary and alternative medicine;Suggestions for nutrition management.[Conclusions]1.Five-step nutritional intervention improved the nutritional status and quality of life of patients in the gastrointestinal tumor intervention group and reduced adverse reactions to chemotherapy,which is worthy of clinical promotion.2.Five-step nutritional intervention enables patients to have a positive experience of being cared for and valued,and changes their previous poor lifestyle.Medical staff should pay attention to patients' behavior of collecting dietary folk prescription in the early stage of disease,and use cluster method to carry out health education in the early stage.In the middle stage of the disease,patients were instructed to take ONS in different doses and improve their taste in order to improve the compliance rate.In the rehabilitation period,patients should be reasonably guided to seek rehabilitation treatment of traditional Chinese medicine,and targeted intervention measures should be taken for those who worry about recurrence of psychological problems. |
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