壺腹周圍癌患者術後惡病質之營養照護經驗

The Nutritional Care Experience of a Post-Operative Periampullary Cancer Patient With Cachexia

惡病質是癌症患者最常見但易被輕忽之症狀，特別是腸胃道術後之癌症病患。雖然2015年美國國家癌症資訊網（National Comprehensive CancerNetwork, NCCN）在緩和照護指引中提及惡病質之照護與評估內容，但目前尚未運用於臨床。故筆者透過文獻查證與臨床照護經驗，結合惡病質評估表（Cachexia Assessment Scale, CAS）與部分NCCN緩和照護指引中針對惡病質之照護指引，評估壺腹周圍癌術後患者之營養狀態、身體功能、實驗室檢驗值及腸胃系統，以確定惡病質之程度。並於照護期間，促進病患營養攝取量與增加身體活動，以提升術後體能恢復。藉由實際運用惡病質評估表（CAS）與NCCN照護指引於此個案，以協助臨床工作者瞭解如何運用照護指引於臨床照護。期望護理人員能評估全面性營養狀態及其相關影響因子，並給予適當的介入措施，以減緩惡病質進展，進而提升生活品質。

Cachexia is one of the most widely overlooked of the syndromes that are experienced by cancer patients. This syndrome is especially prevalent among patients with gastroenterology tract cancer. Although the National Comprehensive Cancer Network (NCCN) issued palliative-care practice guidelines for cachexia in 2015, guidelines have yet to be issued for the clinical setting. The authors reviewed the literature and applied their clinical experience to create an approach for identifying the degree of cachexia in a post-operative patient with periampullary cancer. This approach assesses the nutritional status, physical status, laboratory results, and gastrointestinal system functions of the patient using the Cachexia Assessment Scale (CAS) and NCCN Practice Guidelines for Cachexia. The patient improved under nursing care with an increase in nutritional intake and physical activity facilitating their process of post-surgical physical recovery. The authors hope that this experience using the combined CAS-NCCN Practice Guidelines will help clinical caregivers better understand how to apply the relevant guidelines in clinical settings. The developed approach may help nurses assess the comprehensive nutrition status of patients and related factors in order to provide interventions that will decrease the progression of cachexia effectively and promote quality of life.