营养支持治疗对儿童神经母细胞瘤临床疗效的影响
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摘要
目的:评估营养支持治疗对神经母细胞瘤(nueroblastoma,NB)患儿临床疗效的影响。方法:纳入2014年10月至2016年12月期间在我院初诊为NB的患儿106例,分为规范营养支持治疗组(A组)52例和非规范营养支持治疗组(B组)54例,评估2组患儿初诊时营养状况,分析2组患儿在手术后、化疗后其营养学指标变化、肿瘤治疗期间并发症发生率、卫生经济学指标。结果:(1)初诊时、术后及化疗后A组患儿中上臂围分别为(8.2±2.6)、(9.5±2.2)、(9.8±2.0)cm,B组患儿分别为(7.0±2.3)、(6.5±1.4)、(6.5±1.2)cm,A组患儿三角肌皮褶厚度分别为(4.8±1.2)、(6.2±1.6)、(6.4±1.5)mm,B组患儿分别为(3.9±3.4)、(4.5±1.2)、(4.6±1.1)mm,2组间比较有统计学意义(P<0.05),A组各时间点之间比较有统计学意义(P<0.05),而B组无统计学意义(P>0.05)。(2)术后A组出现伤口裂开及感染发生率为1.9%,B组为18.5%,2组间比较有统计学意义(P<0.05)。(3)在化疗4疗程后,A组骨髓抑制、胃肠道症状以及呼吸道感染发生率明显低于B组(P<0.05)。(4)A组平均住院时间、平均住院次数、平均住院费用、非计划再入院率也明显低于B组(P<0.05)。结论:NB患儿经规范营养支持治疗后,可有效改善营养状况,降低手术、化疗带来的并发症,提高患儿对NB治疗耐受性。
Objective:To evaluate the effect of nutritional support therapy on the clinical efficacy of nueroblastoma(NB). Methods:A total of 106 children with NB admitted from October 2014 to December 2016 were enrolled and divided into the nutrition treatment group(group A,52 cases)and non-nutritional treatment group(group B,54 cases). The nutritional status of the two groups at the initial diagnosis was evaluated,and the nutritional indicators,the incidence of complications and the health economics index of the two groups after operation and chemotherapy were analyzed respectively. Results:(1)The middle upper arm circumferences of the children in group A at the initial diagnosis,after operation and after chemotherapy were(8.2±2.6),(9.5±2.2),and(9.8±2.0)cm respectively,while those in group B were(7.0±2.3),(6.5±1.4),(6.5±1.2)cm respectively. The deltoid skin fold thicknesses of the children in group A were(4.8±1.2),(6.2±1.6),(6.4±1.5)mm respectively,while those in group B were(3.9±3.4),(4.5±1.2),(4.6±1.1)mm respectively. The difference between the two groups was significant(P<0.05),and the differences among each two of the three time points in group A were also significant(P<0.05),while which in group B were not significant(P>0.05).(2)Postoperative wound dehiscence and infection complications in children were 1.9% in group A and 18.5% in group B,and the difference between the two groups was significant(P <0.05).(3)After 4 courses of chemotherapy,the incidences of myelosuppression,gastroin testinal symptoms and respiratory tract infection in group A were significantly lower than those in group B(P<0.05).(4)The average hospitalization duration,times,and cost,and the unplanned readmission rate in group A were also significantly lower than those in group B(P<0.05). Conclusion:The standardized nutrition support treatment for NB children can effectively improve the nutritional status,reduce the incidence of complications caused by surgery and chemotherapy,and improve the tolerance of children to tumor treatment.
Objective:To evaluate the effect of nutritional support therapy on the clinical efficacy of nueroblastoma(NB). Methods:A total of 106 children with NB admitted from October 2014 to December 2016 were enrolled and divided into the nutrition treatment group(group A,52 cases)and non-nutritional treatment group(group B,54 cases). The nutritional status of the two groups at the initial diagnosis was evaluated,and the nutritional indicators,the incidence of complications and the health economics index of the two groups after operation and chemotherapy were analyzed respectively. Results:(1)The middle upper arm circumferences of the children in group A at the initial diagnosis,after operation and after chemotherapy were(8.2±2.6),(9.5±2.2),and(9.8±2.0)cm respectively,while those in group B were(7.0±2.3),(6.5±1.4),(6.5±1.2)cm respectively. The deltoid skin fold thicknesses of the children in group A were(4.8±1.2),(6.2±1.6),(6.4±1.5)mm respectively,while those in group B were(3.9±3.4),(4.5±1.2),(4.6±1.1)mm respectively. The difference between the two groups was significant(P<0.05),and the differences among each two of the three time points in group A were also significant(P<0.05),while which in group B were not significant(P>0.05).(2)Postoperative wound dehiscence and infection complications in children were 1.9% in group A and 18.5% in group B,and the difference between the two groups was significant(P <0.05).(3)After 4 courses of chemotherapy,the incidences of myelosuppression,gastroin testinal symptoms and respiratory tract infection in group A were significantly lower than those in group B(P<0.05).(4)The average hospitalization duration,times,and cost,and the unplanned readmission rate in group A were also significantly lower than those in group B(P<0.05). Conclusion:The standardized nutrition support treatment for NB children can effectively improve the nutritional status,reduce the incidence of complications caused by surgery and chemotherapy,and improve the tolerance of children to tumor treatment.
引文
[1] Marian M,August DA. Prevalence of malnutrition and current use of nutrition support in cancer patient study[J]. JPEN J Parenter Enteral Nutr,2014,38(2):163-165.
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[7] Mendes J,Alves P,Amaral TF. Comparison of nutritional status assessment parameters in predicting length of hospital stay in cancer patients[J]. Clinical Nutrition,2014,33(3):466-470.
[8]中国抗癌协会小儿肿瘤专业委员会.儿童神经母细胞瘤诊疗专家共识[J].中华小儿外科杂志,2015,36(1):3-7.
[9]中国营养学会.中国居民膳食营养素参考摄入量(2013版)[M].北京:科学出版社,2014.
[10]黎海芪,毛萌.儿童保健学[M].北京:人民卫生出版社,2011:241.
[11] Mosby TT,Barr RD,Pencharz PB. Nutritional assessment of children with cancer[J]. Journal of Pediatric Oncology Nursing,2009,26(4):186-197.
[12] Gaynor EPT,Sullivan PB. Nutritional status and nutritional management in children with cancer[J]. Arch Dis Child,2015,100:1169-1172.
[13] Bauer J,Jürgens H,Frühwald MC. Important aspects of nutrition in children with cancer[J]. Adv Nutr,2011,2:67-77.
[14] Small AG,Thwe Le W,Byrne JA,et al. Neuroblastoma,body mass index,and survival:a retrospective analysis[J]. Medicine,2015,94(14):1-6.
[15] Tokunaga R,Sakamoto Y,Nakagawa S,et al. Prognostic nutritional index predicts severe complications,recurrence,and poor prognosis in patients with colorectal cancer undergoing primary tumor resection[J]. Dis Colon Rectum,2015,58:1048-1057.
[16] Feng JF,Chen QX. Significance of the prognostic nutritional index in patients with esophageal squamous cell carcinoma[J]. Therapeutics&Clinical Risk Management,2014,10:1-7.
[17] Mendez CM,Mcclain CJ,Marsano LS. Albumin therapy in clinical practice[J]. Nutrition in Clinical Practice,2005,20:314-320.
[18] Grzegorzewska AE,Leander M. Total lymphocyte count and subpopulation lymphocyte counts in relation to dietary intake and nutritional status of peritoneal dialysis patients[J]. Adv Perit Dial,2005,21:35-40.
[19] Akbulut G. New perspective for nutritional support of cancer patients:Enteral/parenteral nutrition[J]. Experimental&Therapeutic Medicine,2011,2(4):675-684.
[2] Hébuterne X,LemariéE,Michallet M,et al. Prevalence of malnutrition and current use of nutrition support in patients with cancer[J].JPEN J Parenter Enteral Nutr,2014,38(2):196-204.
[3]高俊,邱秀娟,王琦三.营养风险筛查对胃癌手术并发症发生率的预测价值[J].中国肿瘤临床,2015,42(5):271-276.
[4]吴国豪.肿瘤患者的营养不良支持[J].中华普通外科学文献,2015,9(6):417-420.
[5] Langius JAE,Zandbergen MC,Eerenstein SEJ,et al. Effect of nutritional interventions on nutritional status,quality of life and mortality in patients with head and neck cancer receiving(chemo)radiotherapy:a systematic review[J]. Clinical Nutrition,2013,32(5):671-678.
[6] Lassen K,Coolsen MM,Slim K,et al. Guidelines for perioperative care for pancreaticoduodenectomy:enhanced recovery after surgery(ERAS)society recommendations[J]. World J Surg,2013,37(2):240-258.
[7] Mendes J,Alves P,Amaral TF. Comparison of nutritional status assessment parameters in predicting length of hospital stay in cancer patients[J]. Clinical Nutrition,2014,33(3):466-470.
[8]中国抗癌协会小儿肿瘤专业委员会.儿童神经母细胞瘤诊疗专家共识[J].中华小儿外科杂志,2015,36(1):3-7.
[9]中国营养学会.中国居民膳食营养素参考摄入量(2013版)[M].北京:科学出版社,2014.
[10]黎海芪,毛萌.儿童保健学[M].北京:人民卫生出版社,2011:241.
[11] Mosby TT,Barr RD,Pencharz PB. Nutritional assessment of children with cancer[J]. Journal of Pediatric Oncology Nursing,2009,26(4):186-197.
[12] Gaynor EPT,Sullivan PB. Nutritional status and nutritional management in children with cancer[J]. Arch Dis Child,2015,100:1169-1172.
[13] Bauer J,Jürgens H,Frühwald MC. Important aspects of nutrition in children with cancer[J]. Adv Nutr,2011,2:67-77.
[14] Small AG,Thwe Le W,Byrne JA,et al. Neuroblastoma,body mass index,and survival:a retrospective analysis[J]. Medicine,2015,94(14):1-6.
[15] Tokunaga R,Sakamoto Y,Nakagawa S,et al. Prognostic nutritional index predicts severe complications,recurrence,and poor prognosis in patients with colorectal cancer undergoing primary tumor resection[J]. Dis Colon Rectum,2015,58:1048-1057.
[16] Feng JF,Chen QX. Significance of the prognostic nutritional index in patients with esophageal squamous cell carcinoma[J]. Therapeutics&Clinical Risk Management,2014,10:1-7.
[17] Mendez CM,Mcclain CJ,Marsano LS. Albumin therapy in clinical practice[J]. Nutrition in Clinical Practice,2005,20:314-320.
[18] Grzegorzewska AE,Leander M. Total lymphocyte count and subpopulation lymphocyte counts in relation to dietary intake and nutritional status of peritoneal dialysis patients[J]. Adv Perit Dial,2005,21:35-40.
[19] Akbulut G. New perspective for nutritional support of cancer patients:Enteral/parenteral nutrition[J]. Experimental&Therapeutic Medicine,2011,2(4):675-684.