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目的 探讨俯卧位通气在脓毒症合并急性肺损伤患儿的应用效果。方法 选取泉州市儿童医院2020年9月—2023年9月收治的72例脓毒症合并急性肺损伤患儿,应用抽签法将其分为观察组与对照组,均为36例。对照组患儿实施常规仰卧位机械通气与对应护理,观察组患儿在常规护理基础上增加俯卧位通气与对应护理。对比两组患儿机械通气时间,干预前和干预3 d后气道平台压和心率水平,动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2),并计算动脉血氧分压与吸入气中的氧浓度分数比值(PaO2/FiO2),评价两组患儿预后及不良事件发生情况。结果 观察组机械通气时间明显低于对照组(P<0.05),干预后两组患儿气道平台压、心率均降低,且观察组低于对照组(P<0.05);干预后两组患儿PaO2/FiO2、PaO2水平升高,观察组高于对照组,PaCO2降低,观察组低于对照组(P<0.05);干预后两组患儿全身性感染相关性器官功能衰竭评分(SOFA)、急性生理和慢性健康状况评分Ⅱ(APACHEⅡ)评分均降低,观察组低于对照组(P<0.05);两组患儿呼吸机管路折管、管路滑脱、压力性损伤等不良事件发生率对比差异无统计学意义(P>0.05)。结论 俯卧位通气在脓毒症合并急性肺损伤患儿的应用效果显著,可降低患儿气道平台压及心率,缩短机械通气时间,改善患儿通气功能,有助提升预后水平。
Objective To explore the application effect of prone position ventilation in children with sepsis complicated with acute lung injury.Methods From September 2020 to September 2023,72 children with sepsis and acute lung injury admitted to Quanzhou Children's Hospital were selected and divided into observation group and control group by drawing lots,both with 36 cases.The children in the control group received routine supine mechanical ventilation and corresponding nursing,and the children in the observation group added prone ventilation and corresponding nursing on the basis of routine nursing.By comparing the duration of mechanical ventilation,airway plateau pressure and heart rate level,PaCO2,PaO2,PaO2/FiO2,the prognosis and occurrence of adverse events in the two groups were evaluated.Results The mechanical ventilation time in the observation group was significantly shorter than that in the control group(P<0.05).After intervention,the airway plateau pressure and heart rate levels of the two groups of children decreased,and the observation group was lower than the control group(P<0.05).After the intervention,the levels of PaO2/FiO2 and PaO2 in the two groups of children increased,with the observation group higher than the control group,while the level of PaCO2 was lower,with the observation group lower than the control group(P<0.05).After the intervention,the SOFA and APACHE II scores of the two groups of children decreased,and the observation group was lower than the control group(P<0.05).There was no difference in the incidence of adverse events such as ventilator tube folding,tube slip and pressure injury between the two groups(P>0.05).Conclusions The application of prone position ventilation in children with sepsis combined with acute lung injury has a significant effect,which can reduce airway plateau pressure,lower heart rate,shorten mechanical ventilation time,improve ventilation function,and assist in improving prognosis.
论著
目的 探讨护理目标执行理念护理在哮喘患儿治疗中的价值。方法 前瞻性选取泉州市妇幼保健院于2021年8月—2023年8月收治的100例支气管哮喘患儿,应用随机数字表法将其分为两组,每组均为50例。对照组采取常规护理,观察组在常规护理基础上给予护理目标执行理念护理。3个月后,对比两组家属对患儿的疾病管理能力、哮喘控制状况、生活质量。结果 护理后两组患儿家属相关家庭管理测量量表(FaMM)评分均升高,且观察组高于对照组(P<0.05);观察组患儿哮喘控制率高于对照组(P<0.05);护理后两组患儿情感、活动、症状相关标准儿童哮喘生活质量评分表(PAQLQ)评分均升高,且观察组高于对照组(P<0.05)。结论 护理目标执行理念护理可改善哮喘患儿家属对患儿疾病的管理能力,改善哮喘控制效果,提升患儿生活质量。
Objective To explore the value of nursing goal execution concept intervention in the treatment of children with asthma.Methods From August 2021 to August 2023,100 children with bronchial asthma admitted to Quanzhou Maternal and Child Health Hospital were Prospective selected.They were randomly divided into observation group and control group,with 50 cases in each group.The control group of children received routine care,while the observation group of children received intervention based on the nursing goals execution concept in addition to routine care.After 3 months of intervention,The disease management ability,compliance,asthma control and quality of life of the two groups were compared.Results Family-related FaMM scores were increased in all two groups after the intervention,and the observation group was higher than the control group(P<0.05).The asthma control rate of the children in the observation group was higher than that in the control group(P<0.05);after nursing,the PAQLQ score increased,and the observation group was higher than the control group(P<0.05).Conclusions Intervention based on the nursing goals execution concept can improve the management ability of family members of asthma patients towards their diseases,and enhance their quality of life,which is worthy of clinical application and promotion.
论著
目的 探讨时机理论的护理干预在三叉神经痛微血管减压术中的应用效果。方法 选取2020年7月—2023年6月厦门大学附属第一医院神经外科三叉神经痛患者85例,均实施微血管减压术治疗,通过奇偶数抽签的方式分组,即对照组(n=43,予以常规护理)与观察组(n=42,实施常规护理基础上给予基于时机理论的护理干预),通过专业调查表对两组患者疼痛、负面情绪及生活质量进行全面评估。结果 观察组出院时数字分级评分表(NRS)、抑郁自评量表(SDS)、焦虑自评量表(SAS)评分分别为(2.13±0.57)(42.45±3.17)(42.45±3.17)分,低于对照组的(3.23±0.78)(52.34±4.45)(48.23±3.23)分(P<0.05);观察组术后1个月简明健康状况调查表(SF-36)生理功能、生理职能、躯体功能、活力、社会功能、情感职能、心理健康及总体健康状态等维度评分分别为(38.12±8.27)(42.22±9.12)(52.34±8.23)(64.11±8.92)(70.12±9.03)(34.46±6.18)(71.34±8.17)(75.24±8.46)分,高于对照组的(35.23±8.13)(38.56±9.23)(45.03±8.11)(60.57±8.23)(65.23±8.78)(30.14±6.13)(66.23±8.08)(72.12±8.35)分(P<0.05)。结论 三叉神经痛患者实施微血管减压术治疗的同时,采取基于时机理论的护理干预不仅可减轻其疼痛程度,改善其负面情绪,还可全面提高其生活品质。
Objective To explore the application effect of timing theory nursing intervention in microvascular decompression surgery for trigeminal neuralgia.Methods The research period was from July 2020 to June 2023.The study subjects were 85 patients with trigeminal neuralgia selected from the Neurosurgery Department of the First Affiliated Hospital of Xiamen University,all of whom underwent microvascular decompression surgery.They were divided into a control group(n=43,receiving routine care)and an observation group(n=42,receiving timing based nursing intervention on the basis of routine care)through odd and even number drawing.A preliminary assessment of pain,negative emotions,and quality of life for two groups of patients were conducted through a professional questionnaire.Results The scores of NRS,SDS and SAS in the observation group at discharge were(2.13±0.57),(42.45±3.17)and(42.45±3.17)respectively,which were significantly lower than those in the control group(3.23±0.78), (52.34±4.45)and(48.23±3.23).The scores of physiological function,physiological function,physical function,vitality,social function,emotional function,mental health and general health status in the observation group one month after operation were(38.12±8.27),(42.22±9.12),(52.34±8.23), (64.11±8.92), (70.12±9.03), (34.46±6.18), (71.34±8.17) and(75.24±8.46), which were significantly higher than those of the control group(35.23±8.13), (38.56±9.23), (45.03±8.11), (60.57±8.23), (65.23±8.78), (30.14±6.13), (66.23±8.08)and(72.12±8.35)(P<0.05).Conclusions While implementing microvascular decompression surgery for patients with trigeminal neuralgia,nursing interventions based on timing theory can not only alleviate their pain,improve their negative emotions,but also comprehensively improve their quality of life.
论著
目的 对比纳布啡联合环泊酚、纳布啡联合丙泊酚应用于老年患者无痛胃镜中的效果。方法 选取厦门市中医院2021年10月至2022年10月收治的180例老年患者(均行无痛胃肠镜检查)为研究对象,按照随机数表法分组,其中A组90例患者给予纳布啡联合环泊酚,B组90例患者给予纳布啡联合丙泊酚,对比两组患者麻醉相关指标、血流动力学、围术期不良反应。结果 两组患者诱导量、诱导时间、追加次数、总追加量、苏醒时间、恢复室停留时间对比差异均无统计学意义(t=1.486、0.830、1.157、0.941、0.906、1.403,均P>0.05);重复测量方差分析结果显示,分组因素间收缩压(SBP)(F=30.019,P<0.001)、心率(HR)(F=282.057,P<0.001)、SpO2(F=64.518,P<0.001)、;时间因素SBP(F=21.780,P<0.001)、HR(F=345.118,P<0.001)、SpO2(F=41.762,P<0.001);分组与时间交互时间因素SBP(F=12.941,P<0.001)、HR(F=193.295,P<0.001)、SpO2(F=13.546,P<0.001),差异均有统计学意义。折线图直观显示,A组患者SBP、HR、SpO2、较B组低。;A组患者围术期不良反应发生率(20.00%)低于B组患者(56.67%)(χ2=25.593,P<0.001)。结论 两种麻醉方案应用于老年无痛胃肠镜,麻醉效果相近,环泊酚复合纳布啡血流动力学更稳定,且围术期不良反应的发生率较低。
Objective To compare the effects of nalbuphine combined with ciprofol and nalbuphine combined with propofol on painless gastroscopy in elderly patients. Methods A total of 180 elderly patients(all underwent painless gastroscopy)admitted to Xiamen Traditional Chinese Medicine Hospital from October 2021 to October 2022 were selected as the study subjects.They were randomly divided into groups using a random number table method.Among them,90 patients in Group A were given a combination of nalbuphine and ciprofol,while 90 patients in Group B were given a combination of nalbuphine and propofol.Anesthesia related indicators,hemodynamics,and perioperative adverse reactions were compared between the two groups.There was no statistically significant difference in the induction amount,induction time,number of additional times,total additional amount,awakening time,and recovery room stay time between the two groups of patients(t=1.486,0.830,1.157,0.941,0.906,1.403,all P>0.05).The results of repeated measures analysis of variance showed that there were statistically significant differences among the grouping factors,including SBP(F=30.019,P<0.001),HR(F=282.057,P<0.001),SpO2(F=64.518,P<0.001),time factors SBP(F=21.780,P<0.001),HR(F=345.118,P<0.001),SpO2(F=41.762,P<0.001),and interaction factors SBP(F=12.941,P<0.001),HR(F=193.295,P<0.001),and SpO2(F=13.546,P<0.001).The line chart visually shows that the SBP,HR,SpO2 of Group A patients were lower than those of Group B.The incidence of perioperative adverse reactions in Group A patients(20.00%)was lower than that in Group B patients(56.67%)(χ2=25.593,P<0.001). Conclusions The two anesthesia regimens used for elderly painless gastroscopy have similar anesthesia effects,with more stable hemodynamics of ciprofol combined with nalbuphine,and a lower incidence of perioperative adverse reactions.
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目的 探讨无痛消化内镜下高频电刀治疗对胃癌前病变的应用效果及复发率的影响。方法 选取甘肃医学院附属医院2017年1月—2020年1月收治的120例胃癌前病变患者进行回顾性分析,依照其手术治疗方案将其分为两组,各60例。对照组采取常规内镜黏膜下剥离术,观察组患者采取无痛消化内镜下高频电刀剥离治疗。对比两组的切除速度、切除面积、治愈性切除率、完全及整块切除率,对患者进行3年随访,记录其复发情况,并对比两组患者并发症情况。结果 两组的切除面积、治愈性切除率、完全切除率及整块切除率对比差异无统计学意义(P>0.05),观察组切除速度为(27.34±8.58)mm2/min,高于对照组的(15.54±4.52)mm2/min,差异有统计学意义(P<0.05)。两组患者术后3年的总复发率(28.33% vs 30.00%)对比差异无统计学意义(P>0.05)。观察组感染、穿孔等相关并发症发生率为3.33%,低于对照组的15.00%(P<0.05)。结论 无痛消化内镜下高频电刀与常规内镜黏膜下剥离术治疗胃癌前病变相比具有显著疗效。但无痛消化内镜下高频电刀治疗可提升切除速度,降低并发症发生率。
Objective To explore the application effect and recurrence rate of painless endoscopic high-frequency electrocautery on gastric precancerous lesions.Methods A total of 120 patients with precancerous gastric cancer admitted to the Affiliated Hospital of Gansu Medical College from January 2017 to January 2020 were selected for retrospective analysis and divided into two groups according to their surgical treatment plan,with 60 patients in each group.The control group underwent conventional endoscopic submucosal dissection,and the patients in the observation group received painless digestive endoscopic high-frequency electric knife dissection.The resection speed,resection area,curative resection rate,complete and bulk resection rate were compared of the two groups,the patients were followed up for 3 years to record the recurrence rate,and the complications of the two groups of patients were also compared.Results There were no differences in resection area,curative resection rate,complete resection rate and total resection rate between the two groups(P>0.05).The resection speed in the observation group was(27.34±8.58)mm2/min,which was higher than that in the control group(15.54±4.52)mm2/min(P<0.05).There was no difference in the total recurrence rate(28.33% vs 30.00%)at 3 years after surgery between the two groups(P>0.05).The incidence of infection,perforation and other related complications in the observation group was 3.33%,lower than that in the control group(15.00%)(P<0.05).Conclusion sCompared with conventional endoscopic submucosal dissection,high-frequency electric knife under painless digestive endoscopy has significant efficacy in the treatment of gastric precancerous lesions.However,painless endoscopic high-frequency electrosurgical treatment can improve the resection speed and reduce the incidence of complications such as infection,perforation and bleeding.
论著
目的 探讨脊柱外科围术期康复指导方案的临床疗效。方法 选取毕节市第三人民医院脊柱外科184例行择期手术治疗的患者,对照组继续脊柱外科原康复方案行术前及术后管理,观察组使用新的康复行为规范方案,即系统行术前预康复指导和术后规范管理。对患者的术后起床活动、在院时间、住院费用、疼痛恢复情况、满意调查情况进行对比。结果 术前,患者的性别、年龄、病种分布对比差异无统计学意义(P>0.05)。术后,观察组的术后下床活动时间(3.09±1.02)d、住院时间(10.73±3.96)d、住院费用(17 388±5 217)元、术后2天VAS评分(3.04±1.19)分、出院时VAS评分(2.36±1.25)分、住院患者满意度(89.80±8.20)分,均优于对照组的术后起床活动时间(4.44±1.58)d、住院时间(13.38±2.73)d、住院费用(23 242±7 971)元、术后2天VAS评分(4.01±1.44)分、出院时VAS评分(3.39±1.38)分、住院满意度(80.27±11.45)分。新的康复指导方案在脊柱外科患者中较对照组减轻术后疼痛、减少患者卧床时间及缩短住院时间(P<0.05)。结论 围手术期加快患者术后康复及提高术后恢复优良率,提高患者就医满意度,使医患关系更加融洽。
Objective To investigate the clinical effect of the rehabilitation guidance protocol of spinal surgery in perioperative period.Methods A total of 184 patients undergoing selective surgery in the spine surgery department of the Third People's Hospital of Bijie City were selected.The conventional rehabilitation group was the control group,which preoperative and postoperative management was continued with the original rehabilitation program of spine surgery;the rehabilitation guidance group was the observation group:the new rehabilitation behavior code program was used to provide systematic preoperative pre-rehabilitation guidance and postoperative standardized management.The patients' activities of getting up after surgery,days in hospital,economic use,pain recovery and satisfaction survey were compared.Results Before surgical treatment,the gender,age and disease distribution of patients were compared(P>0.05).After surgical treatment,observation group:Postoperative time of getting out of bed(3.09±1.02)d,length of hospitalization(10.73±3.96)d,hospitalization expenses(17 388±5 217)yuan,VAS score of 2 days after surgery(3.04±1.19),VAS score of discharge(2.36±1.25),inpatient satisfaction(89.80±8.12),were significantly better than the control group:Postoperative activity time(4.44±1.58)d,length of hospitalization(13.38±2.73)d,hospitalization expenses(23 242±7 971)yuan,VAS score(4.01±1.44),VAS score at discharge(3.39±1.38),hospitalization satisfaction(80.27±11.45).Compared with the control group,the new rehabilitation guidelines significantly reduced postoperative pain,bed time and hospital days in spinal surgery patients(P<0.05).Conclusions Speeding up the postoperative rehabilitation of patients and improving the rate of postoperative recovery,improving patients' sense of access to medical treatment,can make the doctor-patient relationship more harmonious.
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目的 观察阶梯式呼吸管理策略在改善感染性休克伴急性肺损伤(ALI)患者中的价值。方法 纳入我院2019年1月—2020年12月收治的感染性休克伴ALI患者共146例为研究对象,数字表法随机分为观察组(73例)与对照组(73例)。对照组常规护理方案,观察组阶梯式呼吸管理,对比干预前后患者心肺功能的差异。结果 观察组平均动脉压、PaCO2水平低于对照组,心脏指数、中心静脉压、血管外肺水指数、PaO2与氧合指数高于对照组(P<0.05);观察组复苏成功率与临床总有效率高于对照组,复苏时间与呼吸平稳时间低于对照组(P<0.05);观察组气管切开率、有创呼吸机使用率及呼吸机相关性肺炎与气道并发症发生率均低于对照组(P<0.05)。结论 感染性休克并急性肺损伤患者建立阶梯化呼吸管理策略能够显著改善患者的心肺功能,提高临床复苏效果,降低相关并发症风险。
Objective To observe the value of stepwise respiratory management strategy in improving patients with septic shock and acute lung injury(ALI).Methods A total of 146 patients with septic shock and ALI treated in our hospital from January 2019 to December 2020 were included as the research objects.They were randomly divided into observation group(73 cases)and control group(73 cases)by digital table method.The control group received routine nursing plan,and the observation group received stepwise respiratory management.The differences of cardiopulmonary function before and after the intervention were compared.Results The levels of mean arterial pressure,PaCO2 in the observation group were significantly lower than those in the control group,cardiac index,central venous pressure,extravascular lung water index,PaO2 and oxygenation index in the observation group were significantly higher than those in the control group(P<0.05).The success rate of resuscitation and total clinical effective rate in the observation group were significantly higher than those in the control group,and the resuscitation time and respiratory stability time in the observation group were significantly shorter than those in the control group(P<0.05).The tracheotomy rate,the rate of using invasive ventilator and the incidence of ventilator associated pneumonia and airway complications in the observation group were lower than those in the control group(P<0.05).Conclusions The establishment of stepwise respiratory management strategy in patients with septic shock and ALI can significantly improve their cardiopulmonary function,improve the effect of clinical resuscitation and reduce the risk of related complications.
临床诊疗
目的 探讨基于5A模式对急性心肌梗死经皮冠状动脉介入治疗(PCI)术后患者早期心脏康复的应用效果。方法 根据随机数字表法将2021年1月—2022年6月来我院接受治疗的80例急性心肌梗死PCI术后患者分为对照组40例与干预组40例。对照组患者在常规护理模式下进行早期心脏康复,干预组患者在基于5A模式下进行早期心脏康复。对比2组患者的心功能与运动能力情况、自我管理能力以及护理依从性。结果 干预2个月后2组患者的左室射血分数、6分钟步行试验距离水平高于干预前,且干预组高于对照组(P<0.05);左室收缩末期内径水平低于干预前,且干预组低于对照组(P<0.05);2组患者干预2个月后的日常生活、疾病管理、情绪控制以及自我管理总分均高于干预前,且干预组高于对照组(P<0.05);干预组的护理总依从率高于对照组(P<0.05)。结论 对急性心肌梗死PCI术后患者给予基于5A模式进行的早期心脏康复可改善其心功能,提升预后自我管理能力,增强护理干预依从性。
论著
目的 探讨透明帽辅助下套扎切除小胃肠道间质瘤(gastrointestinal stromal tumor,GIST)的临床应用价值。方法 回顾性分析2017年2月—2020年2月在我院行透明帽辅助下小GIST套扎切除术151例患者的临床资料,分析其完整切除率、复发率、并发症发生率、手术时间、住院天数等指标。结果 151例小GIST患者中,瘤体位于胃底91例,胃体53例,胃窦7例,均采用透明帽辅助下完整切除病变。150例病变部位切除后肉眼及病理所见包膜完整无残留,1例分2次套扎后才完全切除肉眼无残留。术中活动性出血3例,无术后迟发性出血,术中主动穿孔105例,穿孔直径最大约1 cm。发生气胸及纵隔气肿3例,局限性腹膜炎3例,发热4例。所有病例经内镜下止血、修补及对症处理后均好转,无1例术中及术后转外科治疗;平均手术时间(28.3±7.6)min,平均住院时间为(4.3 ±1.9)天。病理结果显示极低危险度胃肠道间质瘤132例,低危险度胃肠道间质瘤19例。术后随访复查胃镜均无复发征象。结论 透明帽辅助下套扎切除术胃小GIST操作简单,安全、有效,具有临床推广的价值。
Objective To explore the clinical value of resection of small gastrointestinal stromal tumor(GIST) with transparent cap assisted band ligation. Methods The clinical data of 151 patients who underwent ligation of small GIST assisted with transparent cap in our hospital from February 2017 to February 2020 were retrospectively analyzed, and the complete resection rate, recurrence rate, and complication rate, operation time, hospitalization days and other indicators were analyzed. Results Among the 151 patients with small GIST, 91 cases were located in the fundus of the stomach, 53 cases were in the stomach body, and 7 cases were in the antrum of the stomach. All the lesions were completely resected with the aid of transparent cap. Among lesions of 150 cases, the envelopes were intact and no residue was seen by naked eyes and pathology examination, and 1 case was completely resected after 2 ligations. There were 3 cases of active bleeding, no delayed bleeding, and 105 cases of iatrogenic perforation during the operation. The maximum diameter of the perforation was about 1 cm. There were 3 cases of pneumothorax and mediastinal emphysema, 3 cases of localized peritonitis, and 4 cases of fever. After hemostasis, repair and symptomatic treatment under endoscopy, no case was transferred to surgical departmat during or after operation; the average operation time was (28.3±7.6) minutes, and the average hospital stay was (4.3±1.9) days. Pathological results showed there were 132 cases of very low-risk gastrointestinal stromal tumors and 19 cases of low-risk gastrointestinal stromal tumors. There was no sign of recurrence in the gastroscope during the follow-up. Conclusion The transparent cap assisted ligation resection of small GIST was simple, safe and effective, and had the value of clinical promotion.
论著
目的 评估基于NRS2002系统的多学科营养支持对直肠癌放化疗患者的作用。方法 选取2017年2月—2020年2月我院收治的96例直肠癌放化疗患者作为研究对象,根据入院建档顺序不同分2组,每组48例,对照组接受常规护理,观察组接受基于NRS2002系统的多学科营养支持。比较2组干预前后主观全面评定法(PG-SGA)评分、营养指标[前白蛋白(prealbumin, PA)、血清白蛋白(serum albumin, SA)、转铁蛋白(transferrin, TF)]、癌因性疲乏、生存质量(FLIC评分)。结果 干预后观察组营养状况优于对照组(P<0.05);干预后观察组SA、PA、TF高于对照组(P<0.05);干预后观察组癌因性疲乏低于对照组(P<0.05);干预后观察组生存质量FLIC各维度评分高于对照组(P<0.05)。结论 基于NRS2002系统的多学科营养支持有助于改善直肠癌放化疗患者营养状态,减轻癌因性疲乏,提升生存质量水平。
Objective To evaluate the efficacy of multidisciplinary nutritional support through NRS2002 system on patients undergoing radiotherapy and chemotherapy with rectal cancer. Methods From February 2017 to February 2020, 96 cases of rectal cancer patients undergoing radiotherapy and chemotherapy in our hospital were selected as the research objects, which were divided into two groups according to the order of filing, 48 cases in each group. The control group received routine nursing, and the observation group received multidisciplinary nutritional support through NRS2002 system. The PG-SGA score, nutritional indexes [prealbumin (PA), serum albumin (SA), transferrin (TF)], cancer-related fatigue and quality of life (FLIC score) were compared between two groups before and after intervention. Results After the intervention, the nutritional status of the observation group was better than that of the control group (P<0.05). The SA, PA, TF of the observation group were higher than those of the control group (P<0.05). The cancer-related fatigue of the observation group was lower than that of the control group (P<0.05), and the FLIC score of the observation group was higher than that of the control group (P<0.05). Conclusion Multidisciplinary nutritional support through NRS2002 system was helpful to improve nutritional status of patients, reduce cancer-related fatigue and improve quality of life of patients with rectal cancer undergoing radiotherapy and chemotherapy.