Consruction And Preliminary Application Of Diet Training Scheme For Patients With Esophageal Carcinoma Undergoing Operation

Objective1.To understand the diet problem and dietary needs of patients with reconstruction of digestive pattern after surgery.2.To construct a diet training scheme for patients undergoing esophageal carcinoma(EC)surgery.3.To verify the application effect of the diet training scheme for postoperative patients.Methods1.By reviewing the literature,combing the relevant contents of dietary guidance for esophageal cancer patients at home and abroad,and combining with semi-structured interviews(interviewing 6 medical staff,2 dietitians and 14 patients after esophageal cancer surgery).To understand the experience and dietary needs for postoperative with eating changes,and the advances and requirements of dietary training programs for medical staff and dietitians.The dietary training program for patients undergoing esophageal cancer surgery was preliminarily constructed,and the contents were revised by Deiphi expert consultation method.Six patients with esophageal cancer were pre-tested to verify the feasibility of dietary training program,revised the content of the diet training program and determined according to the pre-test opinions.2.79 patients with esophageal cancer were divided into intervention group and control group.The control group was given routine dietary education and discharge die guidance during the hospitalization period.Nutrition instruction was distributed at discharge and telephone follow-up was conducted once a week.The intervention group was given dietary training during hospitalization and dietary training pictures at discharge on the basis of routine dietary guidance.The intervention period was from hospitalization to one month after discharge.Then to explore the effects of dietary training programs on outcomes of gastrointestinal symptoms,PG-SGA,blood biochemical indicators and quality of life in patients with esophageal cancer.Results1.The results of semi-structured interviews showed that the patients with esophageal cancer had obvious gastrointestinal symptoms,changed eating habits and eager for knowledge guidance;changed eating increased the psychological burden of patients;medical experts and nutritionists emphasized the importance of dietary training during hospitalization,focusing on eating requirements and program training.2.After two rounds of expert consultation by 12 medical and nutritional experts,dietary training program was finally formed,including dietary guidance and swallowing training,15 items of dietary training program.The intervention was divided into two periods:preoperative(from admission to 1 day before operation)and post-operation(from eating semi-liquid to discharge).3.Dietary training program can help alleviate gastrointestinal symptoms and improve nutritional status of patients.3.1 After dietary training intervention,the total score of gastrointestinal symptoms in the intervention group decreased(Z=-4.991,P<0.001)and the PG-SGA score decreased(Z=-5.069,P<0.001).The hemoglobin,albumin and prealbumin in blood biochemistry in the intervention group were higher(Z=-3.057 P<0.05,Z=-2.766,P<0.05,Z=-2.791,P<0.05).In terms of quality(QLQ-C30),the scores of physical function,social function and overall quality of life in intervention group were higher(Z=-2.606,P<0.05,Z=-2.597,P<0.05,Z=-3.500,P<0.001),and the scores of eating,reflux,pain and obstruction in intervention group were lower(Z=-3.390,P<0.05,Z=-3.197,P<0.05,Z=-2.668,P<0.001).P<0.05,Z=-4.429,P<0.001).3.2 The difference of gastrointestinal symptoms score and PG-SGA in the intervention group was lower than that in the control group(Z=-4.733,P<0.001,Z=-4.733,P<0.001);the difference of hemoglobin,albumin and prealbumin in blood biochemistry was higher than those in the control group(Z=-3.190,P<0.05,t=0.404,P<0.05,Z=-3.276,P<0.05).Conclusions1.According to the changes of eating patterns after esophageal cancer surgery,this study constructs a dietary training program.After expert consultation and pre-test,it has certain feasibility,practicability and scientificity.2.Dietary training program can alleviate the gastrointestinal symptoms of patients with esophageal cancer after operation,and was superior to the control group in acid reflux,abdominal distension and belching.3.Dietary training program can effectively improve the nutritional status of patients with esophageal cancer after operation,improve their quality of life,and is suitable for clinical applications.