[1]辛晓伟,方 玉,龚丽青,等.全程营养管理在晚期胃癌化疗病人中的应用[J].肠外与肠内营养杂志,2019,(04):193-197.[doi:DOI : 10.16151/j.1007-810x.2019.04.001]
　XIN Xiao-Wei,FANG Yu,GONG Li-Qing,et al.Application of whole-course nutrition management in patients with advanced gastric cancer undergoing chemotherapy[J].PARENTERAL & ENTERAL NUTRITION,2019,(04):193-197.[doi:DOI : 10.16151/j.1007-810x.2019.04.001]
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全程营养管理在晚期胃癌化疗病人中的应用
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《肠外与肠内营养》杂志[ISSN:1007-810X/CN:32-1477/R]

卷:
期数:
2019年04期
页码:
193-197
栏目:
论著
出版日期:
2019-07-10

文章信息/Info

Title:
Application of whole-course nutrition management in patients with advanced gastric cancer undergoing chemotherapy
作者:
辛晓伟 1; 方 玉 2; 龚丽青 2; 王艳莉 2; 张小田 3; 鲁志豪3
1.国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院营养室，北京 100021；2.北京大学肿瘤医院暨北京市肿瘤防治研究所临床营养科，恶性肿瘤发病机制及转化研究教育部重点实验室，北京 100142；3.北京大学肿瘤医院暨北京市肿瘤防治研究所消化肿瘤内科，恶性肿瘤发病机制及转化研究教育部重点实验室，北京 100142
Author(s):
XIN Xiao-Wei1;  FANG Yu2;  GONG Li-Qing2;  WANG Yan-Li2;  ZHANG Xiao-Tian3;  LU Zhi-Hao3
1. National Cancer Center/National Clinical Research Center for Cancer/Department of Nutrition,Cancer Hospital , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021；2. Key laboratory of Carcinogenesis and Translational Research,Ministry of Education/Beijing, Department of Clinical Nutrition, Peking University Cancer Hospital and Institute, Beijing 100142, China；3.Key laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing, Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute,Beijing 100142, China
关键词:
上消化道肿瘤 ; 化疗 ; 营养风险 ; 营养不良 ; 营养管理
Keywords:
Upper gastrointestinal cancer;  Chemotherapy;  Nutritional risk;  Malnutrition;  Nutrition management
分类号:
R735.2
DOI:
DOI : 10.16151/j.1007-810x.2019.04.001
文献标志码:
A
摘要:
目的：观察全程营养管理对晚期胃癌多周期化疗病人营养状况的影响。 方法：对晚期胃癌首次化疗病人进行前瞻性研究，采用 NRS 2002和 PG-SGA进行营养筛查和评价，NRS 2002 < 3及 PG-SGA 0 ~ 3分病人给予饮食指导，NRS 2002 ≥ 3或 PG-SGA ≥ 4分病人根据“营养不良五阶梯治疗原则”进行营养干预，对营养支持病人定期进行监测及评效，比较化疗期间病人的营养状况、体质量、能量及蛋白质达标情况。 结果：44例病人全部完成 6周期化疗，并进行结果分析。第 1 ~ 6周期病人营养风险的发生率逐次减少（56.8% vs 31.8% vs 22.7% vs 18.2% vs 20.5% vs 13.6%，P < 0.001），差异有统计学意义。病人在不同化疗阶段的营养不良发生率差异有统计学意义（P < 0.001）。与第 1周期化疗前比较，有营养风险及中度/重度营养不良病人在第 2 ~ 6周期化疗前体质量基本维持稳定；第 1 ~ 6周期化疗前，有营养风险病人体质量明显低于无营养风险病人（P < 0.05），严重营养不良组病人体质量显著低于营养良好/可疑营养不良组（P < 0.05），中度营养不良组与营养良好/可疑营养不良组相比无显著性差异（P > 0.05）。第 1、2、3、4、5周期化疗前饮食热量摄入显著低于目标热量推荐值（P < 0.05）；第 1、2、4、6周期化疗前饮食蛋白质摄入显著低于目标推荐值（P < 0.05）。 结论：随着化疗进行，晚期上消化道肿瘤化疗病人的营养风险及营养不良发生率逐渐减少，体质量丢失减少，病人的营养状况得到维持/改善。
Abstract:
Objective: To observe the effect of whole-course nutrition management on the nutritional status of patients with advanced gastric cancer undergoing multi-cycle chemotherapy. Methods: A prospective study was conducted on patients with advanced gastric cancer undergoing initial chemotherapy. The patients were screened and assessed by NRS 2002 and PG-SGA. The patients with NRS 2002 ≥ 3 or PG-SGA ≥ 4 received nutritional intervention according to the "five-step treatments for malnutrition", and those with NRS 2002 < 3 and PG-SGA 0-3 were given dietary guidance. During the chemotherapy, nutritional status, body weight, energy and protein intakes of the patients were evaluated. Results: All 44 patients completed 6 cycles of chemotherapy and the results were analyzed. The prevalence of nutritional risks were gradually decreased from the first to sixth cycles, with significant differences（56.8% vs 31.8% vs 22.7% vs 18.2% vs 20.5% vs 13.6%, P < 0.001）. The prevalence of malnutrition in different stage of chemotherapy was significantly different (P < 0.001). The body weight of the patients with nutritional risks and moderate/severe malnutrition had no significant change during the chemotherapy. The weight of the patients with nutritional risks was significantly lower than those without nutritional risks (P < 0.05). Similarly, the weight of the patients in the severely malnourished group was markedly lower than in the well-nourished/suspected malnourished group (P < 0.05). There was no significant difference between the moderately malnourished group and the wellnourished/suspected malnourished group (P > 0.05). Dietary caloric intake before chemotherapy in cycles 1 to 5 was significantly lower than the recommended target value (P < 0.05). Dietary protein intake before cycles 1, 2, 4 and 6 were significantly lower than the target recommendation (P < 0.05). Conclusion: With implementation of dietary guidance and/or nutritional intervention, the nutritional risk, prevalence of malnutrition and weight loss in patients with advanced upper gastrointestinal cancer of chemotherapy were reduced, and the nutritional status of patients was maintained/improved.

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备注/Memo

备注/Memo:
基金项目 ：首都临床特色应用发展项目（Z141107002514013） 作者简介 ：辛晓伟，主管营养师，医学硕士，从事医学营养治疗工作。E-mail:13311129551@163.com 通讯作者 ：方 玉，E-mail:fangyu777@vip.sina.com
更新日期/Last Update: 1900-01-01