经鼻肠管肠内营养支持在食管癌放疗患者中的应用

Application of enteral nutrition support via naso -jejunal tube in esophageal carcinoma patients treated with radiotheraphy

目的探讨经鼻肠管肠内营养支持对食管癌放疗患者的影响。方法不可手术的食管鳞癌患者采用随机数字表法随机分成肠内营养组（EN组）36例和对照组38例，所有患者均接受适形调强放疗，同期每周联合紫杉醇＋奈达铂方案化疗。EN组采用徒手方法床边放置鼻肠管，放管第2天后开始进行肠内营养，对照组的患者自行进食。统计两组患者放射治疗前后的体质量、体质量指数、血红蛋白、白蛋白、前白蛋白、淋巴细胞计数的变化，统计患者放疗期间副反应。结果EN组在放疗后各营养指标下降幅度比对照组小，两组差异有统计学意义。EN组平均完成同期每周化疗（4．5±1．1）次，对照组完成同期每周化疗（3．1±2．3）次（t=6．21，P=0．027）。放化疗期间对照组血液系统副反应较EN组重（χ2=24．64，P〈0．01），但两组放射性食管炎严重程度差异无统计学意义。结论食管癌放疗患者经鼻肠管肠内营养支持可改善患者的营养状态，减轻放化疗期间骨髓抑制反应，提高患者对治疗的耐受性。

Objective To investigate the effect of enteral nutrition support via naso -jejunal tube in esopha- geal carcinoma patients treated with radiotheraphy. Methods 36 esophageal carcinoma patients were randomly assigned into enteral nutrition（EN） group,while 38 patients assigned to control group. All patients underwent defini- tion IMRT combined with weekly concurrent chemotherapy of paclitaxel - nedaplatin. The naso - jejunal tubes were bedside inserted by hand in EN group. Enteral nutrition support began the day after the tube insertion. The control group took food orally. Nutrition was assessed through body weight, BMI, lymphocyte, albumin, pre - albumin and hemoglobin. Treatment induced complications were recorded. Results The degree of nutritional reduction was lower in EN group and significantly different with the control group. The EN group underwent （4.5 ± 1.1 ） cycles concurrent chemotherapy, the control group underwent （3.1 ± 2.3 ） cycles concurrent chemotherapy （ t = 6.21, P = 0. 027 ）. The hematotoxicity induced by chemoradiotherapy （CRT） was statistically severe in the control group （ χ2 = 24.64, P 〈 0.01 ） ,while radiation esophagitis was similar between the two groups. Conclusion EN support via naso - jejunal tube in esophageal carcinoma patients treated with radiotheraphy may improve the nutritional status, alleviate CRT induced hematotoxicity,increase tolerance of CRT.