营养支持疗法在终末期恶性肿瘤患者中的应用价值分析
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摘要
目的探讨营养支持疗法在终末期恶性肿瘤患者中的应用价值。方法选取2016年8月至2018年7月武警浙江省总队医院收治的108例终末期恶性肿瘤患者,按照随机数字表将其分为常规组(54例)和营养组(54例)。常规组采取常规抗肿瘤治疗,营养组在此基础上予以营养支持疗法,比较两组患者治疗前后的转铁蛋白(transferrin,TRF)、前白蛋白(prealbumin,PA)、人血白蛋白(albumin,ALB)、体重指数(body mass index,BMI)、上臂肌围(mid-arm muscle circumference,MAMC)、肱三头肌皮褶厚度(triceps skinfold thickness,TSF)以及营养风险等。结果治疗前两组患者的TRF、PA、ALB、BMI、MAMC、TSF等比较差异无显著性(P>0.05)。治疗后营养组患者的TRF、PA、ALB、BMI、MAMC、TSF等指标明显优于常规组和治疗前,差异有显著性(P<0.05);营养组患者无营养风险率显著高于常规组(59.26%vs 22.22%),差异有显著性(P<0.05)。结论营养支持疗法在终末期恶性肿瘤患者具有较高的应用价值,能显著改善患者营养状况。
Objective To explore the value of nutritional support therapy in patients with end-stage malignant tumors. Method 108 patients with end-stage malignant tumors admitted to our hospital from August 2016 to July 2018 were randomly divided into the conventional group(54 cases) and the nutrition group(54 cases). The routine group took conventional anti-tumor. Treatment, nutrition group based on this nutritional support therapy, and compared different groups of patients before and after treatment of TRF, PA, ALB, BMI, MAMC,TSF, and nutritional risk. Result Before treatment, there were no signi?cant differences in TRF, PA, ALB, BMI, MAMC, TSF between the nutrition group and the conventional group(P>0.05). After treatment, TRF, PA, ALB, BMI, MAMC, TSF and other indicators in the nutrition group. Signi?cantly better than the conventional group and before treatment(P<0.05); the nutritional risk rate(59.26% vs22.22%) was signi?cantly higher in the nutrition group than in the conventional group, and the difference was statistically signi?cant(P<0.05). Conclusion Nutritional support therapy has a high application value in patients with end-stage malignant tumors, which can signi?cantly improve the nutritional status of patients.
Objective To explore the value of nutritional support therapy in patients with end-stage malignant tumors. Method 108 patients with end-stage malignant tumors admitted to our hospital from August 2016 to July 2018 were randomly divided into the conventional group(54 cases) and the nutrition group(54 cases). The routine group took conventional anti-tumor. Treatment, nutrition group based on this nutritional support therapy, and compared different groups of patients before and after treatment of TRF, PA, ALB, BMI, MAMC,TSF, and nutritional risk. Result Before treatment, there were no signi?cant differences in TRF, PA, ALB, BMI, MAMC, TSF between the nutrition group and the conventional group(P>0.05). After treatment, TRF, PA, ALB, BMI, MAMC, TSF and other indicators in the nutrition group. Signi?cantly better than the conventional group and before treatment(P<0.05); the nutritional risk rate(59.26% vs22.22%) was signi?cantly higher in the nutrition group than in the conventional group, and the difference was statistically signi?cant(P<0.05). Conclusion Nutritional support therapy has a high application value in patients with end-stage malignant tumors, which can signi?cantly improve the nutritional status of patients.
引文
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[12]Liu Y,Tao KX,Wang GB,et al.Effect of enteral nutrition as replacement of traditional bowel preparation on the intraperitoneal and intraluminal disseminated tumor cells,recurrence and metastasis in patients with colorectal cancer[J].Zhonghua Wei Chang Wai Ke Za Zhi,2013,16(4):350-353.
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[14]张涛,黄浩,胡琴,等.FOLFOX方案联合营养支持治疗胃肠道恶性肿瘤的临床效果分析[J].肿瘤药学,2018,8(4):635-638,652.
[15]Kang K,Shu XL,Zhang YS,et al.Effect of glutamine enriched nutrition support on surgical patients with gastrointestinal tumor:a meta-analysis of randomized controlled trials[J].Chin Med J(Engl),2015,128(2):245-251.
[16]Jiang Q.Effect of Glutamine's nutrition support on the postoperative nutrition and immune function in malignant tumor of gynecology patients[J].Pak J Pharm Sci,2014,27(4Suppl):1023-1027.
[17]Feng Y,Tsai YH,Xiao W,et al.Loss of ADAM17-mediated tumor necrosis factor alpha signaling in intestinal cells attenuates mucosal atrophy in a mouse model of parenteral nutrition[J].Mol Cell Biol,2015,35(21):3604-3621.
[18]Yang JC,Dai YY,Wang LM,et al.Glycemic variation in tumor patients with total parenteral nutrition[J].Chin Med J(Engl),2015,128(15):2034-2039.
[19]于康,周晓容,郭亚芳.恶性肿瘤住院患者营养风险和营养不足发生率及营养支持应用状况调查[J].肿瘤学杂志,2011,1(6):408-411.
[20]车晓玲,翁美玲,邹燕.营养支持治疗对老年终末期恶性肿瘤患者营养状况、厌食行为及癌因性疲乏的影响[J].中国老年学杂志,2017,37(6):1430-1432.
[2]李江红,吕爱明,吕秋波,等.妇科恶性肿瘤患者营养风险、营养不足及营养支持状况的调查[J].中华临床营养杂志,2014,22(5):273-276.
[3]张晓燕,王莹,胡岸涛.某医院95例肝胆胰恶性肿瘤患者围手术期营养支持现况调查分析[J].解放军预防医学杂志,2017,35(11):1425-1427.
[4]Chen Y,Li J,Hu Y,et al.Multi-factors including Inflammatory/Immune,Hormones,Tumor-related Proteins and Nutrition associated with Chronic Prostatitis NIH IIIa+b and IV based on FAMHES project[J].Sci Rep,2017,7(1):9143.
[5]Caglayan K,Oner I,Gunerhan Y,et al.The impact of preoperative immunonutrition and other nutrition models on tumor infiltrative lymphocytes in colorectal cancer patients[J].Am J Surg,2012,204(4):416-421.
[6]李晓林,张皓.肠外营养支持对老年晚期恶性肿瘤患者免疫功能及生活质量的影响[J].江苏医药,2017,43(19):1364-1366.
[7]Flavahan WA,Wu Q,Hitomi M,et al.Brain tumor initiating cells adapt to restricted nutrition through preferential glucose uptake[J].Nat Neurosci,2013,16(10):1373-1382.
[8]Ma C,Tsai H,Su W,et al.Combination of arginine,glutamine,and omega-3 fatty acid supplements for perioperative enteral nutrition in surgical patients with gastric adenocarcinoma or gastrointestinal stromal tumor(GIST):a prospective,randomized,double-blind study[J].J Postgrad Med,2018,64(3):155-163.
[9]周路琦,王昆鹏,杨婕,等.肠外营养支持对消化道恶性肿瘤患者术后的干预作用[J].临床外科杂志,2016,24(4):280-283.
[10]薛楠,麦慧云,谷秀芳,等.90例恶性肿瘤患者营养评价、营养治疗及生活质量调查研究[J].现代生物医学进展,2015,15(17):3313-3315.
[11]杨建刚,张琰君,陈继正,等.50例头颈部恶性肿瘤放疗患者营养支持、心理干预及人文照护综合治疗的疗效观察[J].现代肿瘤医学,2017,25(24):3966-3970.
[12]Liu Y,Tao KX,Wang GB,et al.Effect of enteral nutrition as replacement of traditional bowel preparation on the intraperitoneal and intraluminal disseminated tumor cells,recurrence and metastasis in patients with colorectal cancer[J].Zhonghua Wei Chang Wai Ke Za Zhi,2013,16(4):350-353.
[13]Ose J,Fortner RT,Rinaldi S,et al.Endogenous androgens and risk of epithelial invasive ovarian cancer by tumor characteristics in the European Prospective Investigation into Cancer and Nutrition[J].Int J Cancer,2015,136(2):399-410.
[14]张涛,黄浩,胡琴,等.FOLFOX方案联合营养支持治疗胃肠道恶性肿瘤的临床效果分析[J].肿瘤药学,2018,8(4):635-638,652.
[15]Kang K,Shu XL,Zhang YS,et al.Effect of glutamine enriched nutrition support on surgical patients with gastrointestinal tumor:a meta-analysis of randomized controlled trials[J].Chin Med J(Engl),2015,128(2):245-251.
[16]Jiang Q.Effect of Glutamine's nutrition support on the postoperative nutrition and immune function in malignant tumor of gynecology patients[J].Pak J Pharm Sci,2014,27(4Suppl):1023-1027.
[17]Feng Y,Tsai YH,Xiao W,et al.Loss of ADAM17-mediated tumor necrosis factor alpha signaling in intestinal cells attenuates mucosal atrophy in a mouse model of parenteral nutrition[J].Mol Cell Biol,2015,35(21):3604-3621.
[18]Yang JC,Dai YY,Wang LM,et al.Glycemic variation in tumor patients with total parenteral nutrition[J].Chin Med J(Engl),2015,128(15):2034-2039.
[19]于康,周晓容,郭亚芳.恶性肿瘤住院患者营养风险和营养不足发生率及营养支持应用状况调查[J].肿瘤学杂志,2011,1(6):408-411.
[20]车晓玲,翁美玲,邹燕.营养支持治疗对老年终末期恶性肿瘤患者营养状况、厌食行为及癌因性疲乏的影响[J].中国老年学杂志,2017,37(6):1430-1432.