家庭肠外营养在晚期癌性肠梗阻中的应用分析

The application of home parenteral nutrition in patients with advanced malignant bowel obstruction

目的观察家庭肠外营养对晚期癌性肠梗阻患者营养状况、生活质量及生存时间的影响,探讨其临床价值。方法回顾性分析85例晚期结直肠肿瘤伴消化道梗阻的患者,其中39例接受家庭肠外营养(治疗组),另外46例未接受治疗(对照组)。观察2个月后体重、身体质量指数(BMI)、血清蛋白(白蛋白和前白蛋白)、KPS评分和生活质量(SF-36表)等指标;比较两组的生存时间和生存率;应用logistic多元回归分析不同因素对治疗组生存率的影响。结果 2个月后治疗组SF-36评分、KPS评分及血清前白蛋白均明显高于对照组(44.03±4.01 vs 40.90±2.98,P<0.05;53.75±9.76 vs45.16±10.29,P<0.05;133.94±32.46 mg/L vs 113.74±28.68 mg/L,P<0.05);治疗组平均生存时间及3个月生存率分别为(139.18±65.86)天和69.23%,均明显高于对照组的(106.11±59.42)天和47.82%(P<0.05);治疗组中BMI≥18.5kg/m^2的患者3个月生存率明显高于BMI<18.5kg/m^2者(OR=7.00,95%CI=1.56~31.52,P=0.012),KPS>50分的患者6个月生存率明显高于KPS≤50分者(OR=5.33,95%CI=1.18~24.21,P=0.041),无远处转移的患者6个月生存率明显高于有远处转移者(OR=5.50,95%CI=1.01~29.85,P=0.045),可联合肠内营养的患者3个月及6个月生存率均高于不能联合者(OR=8.80,95%CI=0.99~78.11,P=0.034;OR=6.72,95%CI=1.53~21.61,P=0.013)。结论家庭肠外营养可改善晚期癌性肠梗阻患者营养状况、体力水平及生活质量,并延长生存时间,BMI≥18.5、KPS>50分、无远处转移及可联合肠内营养的患者疗效更佳。

Objective To observe the effect of HPN on the nutritional status, quality of life and survival time of patients with malignant bowel obstruction. Methods A retrospective analysis was performed on 85 patients with malignant bowel obstruction caused by advanced colorectal cancer. There were 39 patients who received home parenteral nutrition in treatment group, and the other 46 patients who didn＇t receive treatment in control group. The body weight, BMI, serum protein （albumin and prealbumin）, KPS score and quality of life （SF-36 index） after 1 and 2 months were observed. and then we compared the survival time and 3 months＇ survival rate between two groups. In treatment group, the effects of different factors on survival rate were analysed by logistic regression model. Complications of HPN and reasons for discontinuation of treatment were recorded. Results The SF-36 score、KPS score and serum albumin levels in both group decreased after 1 and 2 months compared with the baseline, but the treatment group has lower reduction. The SF-36 score in the treatment group were significantly higher than that in the control group after 1 month （43.61±3.81 vs 41.10±3.13, P 〈 0.05）. The above three parameters in the treatment group were significantly higher than those in the control group after 2 months. （44.03±4.01 vs 40.90±2.98, P 〈 0.05; 53.75±9.76 vs 45.16±10.29, P 〈 0.05; 133.94 ± 32.46 vs 113.74 ± 28.68, P 〈 0.05）.The average survival time and 3 months survival rate in treatment group were （139.18 ± 65.86） days and 69.23%, which were significantly higher than （106.11 ±59.42） days and 47.82% in the control group respectively （t=2.4327, P 〈 0.05; 2,2=3.961, P 〈 0.05）; In the treatment group, the patients whose BMI were no less than 18.5kg/m^2 had significantly higher 3 month survival rate than the other patients （OR=7.00, 95%CI=1.56-31.52, P=0.012）, KPS 〉 50 have significantly higher 6 month survival rate than KPS ≤ 50 patients （OR=5.33, 95%CI=1.18-24.21, P=0.041）, patients without distant metastasis had significantly higher 6 month survival rate than patients with distant metastasis （OR=5.50, 95%CI=1.01-29.85, P=0.045）. Patients with enteral nutrition had higher 3 and 6 month survival rate than patients without enteral nutrition （OR=8.80,95%CI=0.99-78.11, P=0.034; OR=6.72, 95%CI= 1.53-21.61, P=0.013） . Fifteen cases of complications occurred in treatment group. There were 7 patients discontinued treatment were due to complications, Thirteen patients were due to cost, and the other 19 patients were due to illness or death. Conclusion HPN can improve the nutritional status, physical level, quality of life and prolong the survival time in patients with malignant bowel obstruction caused by advanced colorectal cancer. BMI ≥ 18.5kg/m^2, KPS 〉 50, distant metastasis and with enteral nutrition can get better therapeutic effect.