营养干预在晚期上消化道肿瘤化疗患者中的应用

Nutrition intervention in advanced upper gastrointestinal cancer patients undergoing chemotherapy

目的评价营养干预对晚期上消化道肿瘤患者化疗前后营养状况变化的影响。方法选取82例晚期上消化道肿瘤患者,采用NRS 2002和PG-SGA进行营养筛查和评价,根据PG-SGA评价结果将患者的营养状况分为A(营养良好)、B(可疑/中度营养不良)、C(重度营养不良)三组,根据"营养不良五阶梯治疗原则"进行营养干预,比较干预前后三组患者的营养状况、体重、能量及蛋白质摄入等变化情况。结果干预前营养良好患者10.98%(9/82),可疑/中度营养不良患者50.00%(41/82),重度营养不良患者39.02%(32/82)。干预后患者的营养风险和营养不良发生率降低,干预前分别为52.44%和89.02%,干预后分别为35.37%和75.61%。营养干预前后体重比较,营养良好组[(67.88±11.25)kg vs(67.22±10.17)kg,P>0.05]和可疑/中度营养不良组[(63.00±11.50)kg vs(62.58±11.48)kg,P>0.05]患者维持稳定;重度营养不良组[(59.92±9.61)kg vs(59.15±9.46 kg),P<0.05]体重显著减少。干预前后对比,每天膳食平均摄入能量及蛋白质摄入量可疑/中度营养不良组和重度营养不良组有显著增加(P<0.05);营养良好组无显著增加(P>0.05)。结论营养干预可降低晚期上消化道肿瘤化疗患者的营养风险及营养不良发生率,减少患者体重丢失,改善患者营养状况,有助于改善临床结局。

Objective To evaluate the effect of nutritional intervention on the nutritional status of patients with uppergastrointestinal cancer before and after chemotherapy. Methods Advanced upper gastrointestinal cancer patients （n=82） werescreened and assessed by NRS 2002 and PG-SGA. According to the results of PG-SGA, the patients were divided into three groups：well-nourished （A）, moderately malnourished or suspected of being malnourished （B） and severely malnourished （C）. Nutritionalintervention is based on the ＂five steps of malnutrition＂. Nutritional status, weight, energy and protein intakes of the patients werecompared before and after chemotherapy. Results Before intervention well-nourished patient was 10.98%（8/82）, moderatelymalnourished or suspected of being malnourished was 50.00%（41/82）, severely malnourished was 39.02%（32/82）. The incidenceof nutritional risk and malnutrition after intervention decreased, before intervention was 52.44% and 89.02% respectively, afterintervention was 35.37% and 75.61% respectively. Compared to before chemotherapy, the weight of patients in well-nourished groupand moderately malnourished or suspected of being malnourished group maintained stability, [（67.88±11.25） kg vs （67.22±10.17）kg, P〉0.05 and （63.00±11.50） kg vs （62.58±11.48） kg, P〉0.05], respectively. While in severely malnourished group, weight losssignificantly [（59.92±9.61） kg vs （59.15±9.46） kg, P〈0.05]. The average daily dietary intake of energy and protein increasedsignificantly of moderately malnourished or suspected of being malnourished group and severely malnourished group, compared tobefore intervention （P〈0.05） well-nourished group maintained stability （P〉0.05）. Conclusions Nutritional intervention can reducethe incidence of nutritional risk and malnutrition of patients with advanced upper gastrointestinal cancer, decrease weight loss,improve nutritional status, and may help to improve the clinical outcome.