梁海 沈娟 邓郡 李晓霞 嵇云鹏 张金莲 李芸 程刚 曾诚

摘 要 目的：建立肿瘤营养规范化治疗合理性评价标准，为肿瘤患者的营养规范化治疗提供参考。方法：以国内外肿瘤营养相关治疗指南或专家共识为依据，在征求专家意见基础上，制定我院（亳州市人民医院）肿瘤营养规范化治疗合理性评价标准。应用加权优劣解距离法（TOPSIS）对我院2019年1-6月50份营养治疗病历（A组）进行评价，根据评价结果进行营养干预，并对干预后的2019年8-12月的50份营养治疗病历（B组）进行同法再评价。结果：建立的我院肿瘤营养规范化治疗合理性评价标准包括营养不良诊断、营养不良的性质描述、营养筛查与评估等18项指标。经分析，A组病历营养治疗合理率仅为18%（9份病历与理想解的相对接近程度≥0.6），B组病历其营养治疗合理率为78%（39份病历与理想解的相对接近程度≥0.6）。营养干预前后营养治疗合理性（病历与理想解的相对接近程度≥0.6）差异有统计学意义（P<0.05）。结论：制定的肿瘤营养规范化治疗合理性评价方法切实可行，评价结果直观、合理;营养干预有助于降低营养治疗的不合理率。

关键词 加权优劣解距离法;肿瘤;营养规范化治疗;评价标准;合理应用

中图分类号 R153.9;R969.3 文献标志码 A 文章编号 1001-0408（2021）06-0758-06

ABSTRACT   OBJECTIVE：To establish the evaluation criteria for the rationality of tumor nutritional standardized treatment， and to provide reference for nutritional standardized treatment in tumer patients. METHODS： Based on domestic and foreign guidelines or expert consensus， the rationality evaluation standard of tumor nutritional standardized treatmentwas formulated in our hospital （Bozhou Municipal Peoples Hospital）. 50 nutritional treatment medical records in our hospital from Jan. to Jun. 2019 were evaluated by weighted TOPSIS; according to the evaluation results， nutritional intervention was carried out， and 50 nutritional treatment medical records （group B） from Aug. to Dec. 2019 were re-evaluated by the same method after intervention. RESULTS：The established evaluation criteria for the rationality of tumor nutritional standardized treatment in our hospital included 18 indicators， such as malnutrition diagnosis， description of the nature of malnutrition， nutrition screening and evaluation， etc. After analysis， the rational rate of nutritional treatment was only 18% in group A （Ci of ideal solution with 9 medical records≥0.6）， and 78% in group B （Ci of ideal solution with 59 medical records≥0.6）. There was statistical significance in the rationality of nutritional treatment before and after nutritional intervention （Ci≥0.6） （P<0.05）. CONCLUSIONS：The established rational evaluation method of tumor nutritional standardized treatment is feasible， and the evaluation results are intuitive and reasonable. Nutrition intervention is helpful to reduce the irrational rate of nutritional treatment.

KEYWORDS   Weighted TOPSIS method; Tumor; Nutritional standardized treatment; Evaluation criteria; Rational clinical use

肿瘤患者营养不良和代谢紊乱发生率高，且其贯穿于肿瘤發生、发展的整个病程。相关统计数据表明，40%～80%的肿瘤患者存在营养不良，20%的肿瘤患者直接死于营养不良[1]。营养不良不仅严重影响患者抗肿瘤治疗的依从性和疗效，还会增加其并发症的发生率和病死率，降低患者生活质量、影响患者预后[2-3]。肿瘤营养规范化治疗对于防治肿瘤相关性营养不良有重要意义，其不仅有利于推动营养治疗的合理应用、提升肿瘤的治疗水平，还有助于提高患者的生活质量、延长生存时间[4]。……