消化道恶性肿瘤病人营养支持现况调查

A survey of nutritional support in gastrointestinal cancer patients

目的:调查我院消化肿瘤内科病人营养支持现状,为规范肿瘤病人的临床营养支持提供依据。方法:对我院消化肿瘤内科2012年上半年在住院期间使用过肠内或肠外营养制剂(包括氨基酸)的胃肠道恶性肿瘤病人病历102份进行回顾性调查分析。结果:营养风险筛查尚未纳入消化内科工作常规。总的营养支持率为8.2%。在给予营养支持的病人中,平均营养支持时间为4 d,52.0%的病人<5 d。营养支持供给热量人均为(61.0±28.0)kJ/(kg·d),其中21.1%的病人<41.8 kJ(10 kcal)/(kg·d)。蛋白质平均供给量为(0.4±0.2)g/(kg·d),56.7%的病人蛋白质供给<0.6 g/(kg·d)。EN与PN天数比为1∶2.9。使用PN的病人中47.1%采用个性化配置的全合一制剂,43.3%采用单瓶输注,9.6%采用工业化三腔袋。使用EN的病人中52.7%采用管饲,47.3%采用口服。营养药品费用在所有药品费用中占17.4%,在全部医疗费用中占10.8%。人均营养支持药费为(2 436.2±1 756.2)元。结论:我院消化肿瘤内科病人的营养支持应用不尽合理,尚未开展规范化的营养风险筛查,单瓶输注比例较高,营养支持不足较常见。有必要成立营养支持小组,促进营养支持的个性化、规范化使用。

Objective： To investigate the current status of nutritional support application in pa- tients within gastrointestinal tumor medicine of our hospital. Methods： Gastrointestinal cancer patients who discharged during the first half of 2012 were under investigation and 102 qualified patients who had ever received nutritional support were analyzed. Results： All 102 of patients were eligible. Nutrition risk screen had not been included in routine work. The percentage of nutritional support was 8.2%. The median duration of nutritional support was 4 days, in which 51.96% of patients was less than 5 days. The average energy supply by nutritional support was （61.0 ＋ 28.0） k J/（ kg ~ d）, and 21.1% of patients was fed 〈 41.8 kJ （ 1 0 kcal） / （ kg ~ d）. The average protein supply was 0.4 ＋ 0.2 g/（ kg ~ d）, and 56.7% of patients was fed lower than 0.6 g/（kg ~ d）. The ratio of EN：PN was 1：2.9. In the patients recieved PN, 47.9% fed by personalized all-in-one preparations, 43.3% fed by single bottle sequential prepara- tions, and 9.6% was fed by industrialization three cavity bag. In the patients recieved EN, 52.7% fed by tube, and 47.3% fed by oral. The nutraceuticals~ cost accounted for 17.38% and 10.80% of all drug costs and all medical treatment charge respectively. Per capita nutrition support cost was RMB ~ 2436.2 ＋ 1756.2. Conclusion： The application of nutritional support to gastrointestinal cancer pa- tients was inappropriate in part of patients. Nutrition risk screen had not been included in routine work, the percentage of underfeeding was high and single bottle infusion was common. A nutritional support team should be organized to help improve the prescriptive application of nutritional support therapy.