PALYATİF BAKIM MERKEZİNDE TAKİP EDİLEN HASTALARIN NUTRİSYONEL DURUMLARININ VE SONUÇLARININ DEĞERLENDİRİLMESİ

Year 2024, , 251 - 256, 29.04.2024

Nuray Yılmaz Çakmak , Emine Büşra Yalçıntaş , Kadriye Kahveci

https://doi.org/10.18229/kocatepetip.1397603

Abstract

AMAÇ: Bu çalışmanın amacı palyatif bakım merkezinde takip edilen hastaların nutrisyonel durumlarının ve sonuçlarının incelenmesidir.
GEREÇ VE YÖNTEM: Bu çalışmaya palyatif bakım merkezinde yatarak takip edilen 250 hasta ardışık olarak çalışmaya alındı. Hastalar yatış ve taburculuk durumlarındaki beslenme durumlarına göre gruplandırıldı.
BULGULAR: Çalışmaya katılan hastaların ortalama yaşı 73±19,22 olarak saptandı. Hastalardan 125’i kadın cinsiyete sahipti. Hastaların günlük ortalama ihtiyacı olan kalori 1463,71±21,55 kcal/gün olarak hesaplanırken yattığı dönemde hastalarımızın maksimum tolere edebildiği kalori 1030,54 ±320,54 kcal/gün olarak saptandı (P =0,039). Diyabetik bireylerde hesaplanan kalori ile alabildikleri kalori arasında anlamlı değişiklik saptanmadı (P=0,083). Beslenme şekilleri incelendiğinde palyatif bakım merkezine kabulleri sırasında hastaların %51,60' sının oral yolla beslendiği, perkütan gastrostomi (PEG)/perkütan jejunostomi (PEJ)/nasogastrik tüp ile beslenen hasta oranının ise %32,05 olduğu belirlendi ve hastaların %13,21' si total paranteral nutrisyon (TPN) almıştır. Hastaların %67,06'sı oral yolla beslenme, %30,53'ü PEG/PEJ/nasogastrik tüp ve 4'ü (%2,39) uzun süreli TPN beslenme yöntemleri ile taburcu edilmiştir. Hastalar kalori tüketimlerine göre yüzdelere ayrıldığında, 0-25 persantil kalori alan grupta hastanede yatış gününün anlamlı olarak daha kısa olduğunu tespit ettik (P=0,021) fakat mortalite oranı(%71,42) anlamlı olarak daha yüksekti (P=0,018). 50-75 persentil kalori alımı olan grupta 14(%13,59) hasta ile anlamlı olarak en az oranda yatış süresince mortalite gözlenmiştir(P=0,003). Enfeksiyonlar (%28,57) ise 0-25 grubunda anlamlı derecede yüksekti (P=0,051).
SONUÇ: Palyatif bakım merkezlerinde yaşam sonu yönetimimin yanı sıra hastanın tüm ihtiyaçlarının belirlenmesi gerekmektedir. Katı kalori hesapları yapmak yerine yeni tüm hastalar ile uyumlu beslenme hedeflerinin geliştirilmesi gereklidir.

Keywords

Palyatif bakım, Nütrisyonel Risk Tarama-2002, Beslenme.

EVALUATION OF THE NUTRITIONAL STATUS AND RESULTS OF PATIENTS FOLLOWED IN THE PALLIATIVE CARE CENTER

Abstract

OBJECTIVE: The aim of this study is to examine the nutritional status and results of the patients followed in the palliative care center.
MATERIAL AND METHODS: 250 consecutive patients who were hospitalized in the palliative care center were included in this study. The patients were grouped according to their nutritional status during hospitalization and discharge.
RESULTS: The mean age of the patients subjected to this study is 73±19.22 years. Out of these patients, 125 are female. The average daily calorie requirement of the patients was calculated as 1463.71±21.55 kcal/day, while the maximum tolerated calorie intake was determined to be 1030.54 ±320.54 kcal/day in our patient (P =0.039). No significant change was detected between the calculated calories and the calories consumed by diabetic individuals (P = 0.083). When the nutritional patterns were examined, it was determined that 51.60 % of the patients were orally fed at the time of admission to the palliative care center, the rate of patients fed with a Percutan gastrostomy (PEG)/Percutan jejunostomy (PEJ)/nasogastric tube was 32.05%, and 13.21% of the patients fed total parenteral nutrition (TPN). 67.06% of the patients were discharged with oral feeding, 30.53% with PEG/PEJ/nasogastric tube and 4 (2.39%) with long-term TPN feeding methods. When the patients were divided into percentages according to their calorie consumption, we found that the hospitalization day was significantly shorter in the group consuming 0-25 percentile calories (P = 0.021) but had a significantly higher rate of mortality (%71.42) (P=0.018). In the group with 50-75 percentile calorie intake, mortality was observed significantly at the lowest rate during hospitalization, with 14 (13.59%) patients. (P=0.003). Infections (28.57%) were significantly higher in the 0-25 group (P = 0.051).
CONCLUSIONS: At palliative care centers, besides end-of-life management, all needs of patients should be identified. Instead of making strict calorie calculations, it is necessary to develop new nutritional goals compatible with all patients.

Keywords

Palliative care, Nutrition Risk Screening 2002, Nutrition

References

• 1. Who, “WHO Definition Of Palliative Care” [İnternet]. Available: http://www.who.int/cancer/palliative/definition/en/ (Erişim tarihi: 08-09-2023).
• 2. Cotogni P, Stragliotto S, Ossola M, Collo A, Riso S. The Role of Nutritional Support for Cancer Patients in Palliative Care. Nutrients. 2021;13(2):1–16.
• 3. Forouzanfar MH, Alexander L, Bachman VF, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2015;386(10010):2287– 323
• 4. Parikh RB, Kirch RA, Smith TJ, Temel JS. Early specialty palliative care-translating data in oncology into practice. N Engl J Med. 2013;369(24):2347–2351.
• 5. Bottà G, Binelli G, Agostoni C, et al. Evaluating human basal metabolism: the erroneous and misleading use of so-called "prediction equations". Int J Food Sci Nutr. 2020;71(2):249-255.
• 6. Bendavid I, Lobo DN, Barazzoni R, et al. The centenary of the Harris–Benedict equations: How to assess energy requirements best? Recommendations from the ESPEN expert group. Clinical Nutrition. 2021;40(3):690– 701.
• 7. Bowes HM, Burdon CA, Taylor NAS. The scaling of human basal and resting metabolic rates. Eur J Appl Physiol. 2021;121(1):193–208.
• 8. Kondrup J, Ramussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321–36.
• 9. Huang LH, Lin LS, Wang CL, et al. Palliative Care Consultation Services on Terminally Ill Cancer Patients and Non-Cancer Patients: Trend Analysis from a 9-Year-Long Observational Study in Taiwan. Int J Environ Res Public Health. 2021;18(18).
• 10. Miniksar Ö, Palyatif Bakım Ünitemizde Yatan Hastaların Retrospektif Analizi journal of contemporary medicine. Medicine AAJ of C. 2020.10(3)429- 33.
• 11. Zengin H, Taşçi İ. Factors İnfluencing The Length Of Stay in The Palliative Care Unit in Patients Discharged Home: Results From A Tertiary Hospital in Turkey. Turk J Med Sci. 2021;51(5):2420–6.
• 12. Dos Santos HAV, Leandro-Merhi VA. Can the Nutritional Risk Screening (NRS-2002) predict unfavorable clinical outcome in hospitalized elderly patients? Aging Clin Exp Res. 2022;34(5):1165–9.
• 13. Luca S, Niels H, Ballmer PE, Maya R, Reinhard I. NRS-2002 components, nutritional score and severity of disease score, and their association with hospital length of stay and mortality. Swiss Med Wkly. 2021;151(27):20517.
• 14. Bolayır B, Halil MG. Hospitalize hastalarda nutrisyonel değerlendirme methodu NRS-2002’nin geçerlilik ve güvenilirliğinin değerlendirilmesi. Tıpta uzmanlık tezi, Ankara: Hacettepe Üniversitesi, Hacettepe Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, 2014.
• 15. Yürüyen M., Özbaş Tevetoğlu, I., Tekmen Y., Polat Ö., Arslan İ., Okuturlar Y. "Palyatif Bakım Hastalarında Klinik Özellikler ve Prognostik Faktörler". Konuralp Medical Journal. 2018;(10):74-80.
• 16. Gomes F, Schuetz P, Bounoure L, T, et al. ESPEN guidelines on nutritional support for polymorbid internal medicine patients. Clin Nutr. 2018;37(1):336–53.
• 17. Efendioglu EM, Cigiloglu A, Turkbeyler IH. Malnutrition and Depressive Symptoms in Elderly Palliative Care Patients. J Palliat Care. 2022;37(4):503-509.
• 18. Bowes HM, Burdon CA, Taylor NAS. The scaling of human basal and resting metabolic rates. Eur J Appl Physiol. 202;121(1):193–208.
• 19. Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48–79.
• 20. Klek S, Pawlowska D, Dziwiszek G, et al. The Evolutıon Of Home Enteral Nutrıtıon (Hen) In Poland Durıng Fıve Years After Implementatıon: A Multıcentre Study. Nutr Hosp. 2015;32(1):196–201.
• 21. Shafiekhani M, Nikoupour H, Mirjalili M. The experience and outcomes of multidisciplinary clinical pharmacist-led parenteral nutrition service for individuals with intestinal failure in a center without home parenteral nutrition. Eur J Clin Nutr. 2022;76(6).