위절제수술을 시행한 위암환자의 영양교육 효과평가

Abstract

Objectives: This study is in order to help gastric resection patients staying healthy and improving their life quality by applying nutrition education in their healthy life. Methods: This research has carried out a survey targeting thirty one out-gastric resection patients who has operated anastomosis such as Billroth-Ⅰ(gastroduodenostomy), Billroth-Ⅱ(gastrojejunostomy), Roux-en-Y(esophago jejunostomy) at C University Hospital. The very beginning, they had two sessions for a nutrition education and survey to check their prior body conditions. After three months, we took a second survey used same question as the prior survey. The survey questioned and checked how a nutrition education had an effect such the following sectors; anthropometry investigation, life cycle, eating habits, investigation of food eating frequency, symptom after having food, nutritive control, nutritional intake, life quality, nutritive conditions, blood test, nutritional satisfaction. Anthropometry investigation, life style, and the satisfaction of nutrition education analyze in gender base, and the other researches; analyze the affection of a nutrition education following by anastomosis and disease duration. This study is collected research material from the statistic program named SPSS 18.0(Statistical Package for the Social Sciences, Ver.18.0) and tested by chi-square test, t-test, one-way ANOVA, paired t-test. Results: Along the data of anthropometry investigation in the change of %IBW, nutrition education is influenced to the eating habit, 14.3% very low weight –patients become normal weight that showing very low difference(p＜0.001), eating habit changes from 21.0±3.1 point to 22.3±2.7 point(p=0.009), eating time(p=0.005) and amount of food(p=0.020) are in a slight increase compared before the surgeries. It also shows significant difference in disease duration 1-2(p=0.003), eating time(p=0.005), amount of food(p=0.001) compared to the before. Food intake frequency increases from 27.1±3.9 to 28.3±4.6(p=0.031), there are found significant changes in anastomosis Billroth-Ⅰ(p=0.042) and disease duration 1-2(p=0.033), therefore there are critical relation between nutrition education and food intake frequency. Only 29.0% of the survey group also experiences dumping syndrome compared to 48.4% before the education can be assumed that there is an impact on symptom after meals. Especially, there is a dramatic change in Billroth-Ⅱ from 57.1% to 0%, the symptom can be assumed in remission. Nutritional control for gastrostomy patients increased from 31.7±7.4 to 34.5±6.6(p=0.024), the patients in disease duration 1-2 show significant differency(p=0.015), it also effect on the gastronomy. There is dramatic increase in percentage of average requirement of nutrients uptake rate vitamin C 155.0% to 251.4%(p=0.001), folic acid 159.4% to 199.7%(p=0.004). Vitamin C shows (p=0.022) in anastomosis B-1, (p=0.001) in the duration 1-2, in case as well folic acid (p=0.021) in B-1, (p=0.006) in the duration 1-2, phosphorus (p=0.003) in the duration 3-4. There also are differences in the percentage of enough requirement of nutrients uptake rate; cellulose (p=0.035) in the duration 1-2 and (p=0.012) in anastomosis B-II, manganese (p=0.042) in the duration 1-2. There is a decrease in cholesterol (p=0.045) in the duration 3-4 sector in the percentage of target requirement of nutrients uptake rate. As mentioned, the nutrition education impact on nutrients uptake rate the following nutrients; vitamin C, folic acid, phosphorus, cellulose, manganese, cholesterol. The life quality is in increase from 82.3±11.4 to 85.6±11.2(p=0.018), poor health(p=0.048), anorexia(p=0.002), anxiety(p=0.009), overall life quality(p=0.045) show similar differences. Anastomosis B-Ⅰ increases from 86.1±9.5 to 89.0±9.0(p=0.001). In additional questions, poor health(p=0.004), anorexia(p=0.049) demonstrate variances. The duration 1-2 increases from 82.7±11.6 to 86.7±11.1(p=0.007), there are also differences in anorexia(p=0.005), anxiety(p=0.017), depression(p=0.043), overall life quality(p=0.040). The result says nutrition education also effects on the life quality. PG-SGA in nutritive conditions falls from 4.5±3.8 to 3.7±3.0(p=0.023). In the blood test, Albumin(g/dl) rises from 4.1±0.4 to 4.3±0.3(p=0.014), shows similar changes in the duration 1-2(p=0.014). Hematocrit(%) from 37.5±5.1 to 39.6±4.8(p=0.004), anastomosis B-Ⅰ(p=0.009), the duration 1-2(p=0.004) appearances similar distinction before and after, As the previous data, nutrition education impacts on Albumin, Hematocrit in blood test. The satisfaction of the nutrition education scores total 21.0±3.1, male 22.1±2, female 18.7±2.8(p=0.003). In addition, there are small differences in helping in real life(p=0.004), cooking explanation(p=0.039), educational resources(p=0.001), comprehension of the education(p=0.007). Conclusion: Along the research, nutrition education helps gastric resection patients in the sectors; eating habits, food consuming frequency, nutritional control, nutrients uptake rate, nutritive conditions, better result in blood tests. The survey group recognize the necessary of crucial changes in eating habits, and try to use the knowledge in their life time. However, single nutrition education can be memorized everything, it is necessary following additional educational programs and resources related to nutrition.