恶性肿瘤病人营养诊断及实施流程

Nutrition diagnosis and implementation for cancer patients

恶性肿瘤病人营养不良发生率高,后果严重。营养不良严重危害病人的治疗效果、生存时间以及生活质量。因此,规范肿瘤病人营养不良的诊断方法与标准至关重要。中国抗癌协会肿瘤营养与支持治疗专业委员会推荐:肿瘤病人的营养诊断应该分三级实施,即一级诊断——营养筛查(nutritional screening),病人入院24 h内由护士常规实施完成;二级诊断——营养评估(nutritional assessment),针对全部肿瘤病人在入院后48 h内由营养护士、营养师或医师实施完成。三级诊断——综合评价(comprehensive measurement),针对重度营养不良病人在入院后72 h内由不同学科人员实施完成。根据三级诊断结果,对营养筛查阳性、营养评估阴性(即有营养风险,但是无营养不良)病人可实施营养教育。对营养评估阳性(营养不良)病人,应进一步实施综合评价,并考虑同时实施营养治疗(特指营养教育和人工营养)。对综合评价阴性病人只需要营养治疗,对综合评价阳性(有代谢紊乱)的病人要实施综合治疗。

Malnutrition in cancer patients is very common and results severe consequences. Malnutrition impairs treatment effect, survival time and quality of life. Therefore, it is crucial to standardize the diagnosis of malnutrition in cancer patients. Cancer Nutrition and Supportive Care Committee of China Anti-cancer Association recommends that the diagnosis of malnutrition should be implemented in three levels, namely the first level of diagnosis--nutritional screening, conducting within 24 hours after admission by nurses; the secondary level diagnosis--nutritional assessment, conducting within 48 hours after admission by nutrition nurses, nutritionists or physicians; the third level diagnosis--comprehensive investigation,conducting within 72 hours after admission by muhidisciplinary staffs. Different intervention should be implemented according to the results of the three-level diagnosis. Nutrition education should carry out for patients with risk but no malnutrition. For patients with malnutrition, comprehensive investigation and nutrition therapy （nutrition education and artificial nutrition） should be considered simultaneously. For patients with malnutrition but no metabolic disorders, only nutrition therapy is required, and comprehensive treatment should be carried out for patients with both malnutrition and metabolic disorders.