PALYATİF BAKIM MERKEZİNDE TAKİP EDİLEN HASTALARIN NUTRİSYONEL DURUMLARININ VE SONUÇLARININ DEĞERLENDİRİLMESİ

Year 2024, Volume: 25 Issue: 2, 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

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