肠内外营养对胃肠肿瘤化疗患者营养和毒副反应的观察

Enteral and parenteral nutrition on efficacy and toxicity of chemotherapy for patients with gastrointestinal cancer

目的探讨肠内联合肠外营养治疗对晚期恶性消化道肿瘤患者行2周期化疗后的营养状况、生活质量及化疗毒性和院内感染的影响。方法将100例晚期恶性消化道肿瘤患者随机分为治疗组和对照组,治疗组(50例)采用肠内联合肠外营养同时化疗,对照组(50例)是普通饮食行化疗,每周期化疗前后检测和评估两组患者的营养状况、毒性反应、生活质量指标、院内感染率的变化。结果治疗组患者化疗前和第1周期化疗后与对照组各项营养指标、生活质量、院内感染率相比,均未见临床统计差异。第2周期化疗后,治疗组的体质指数和血红蛋白均明显高于第1周期(19.59±4.05vs18.91±3.36,P<0.05;109.5±7.55g/Lvs103.10±4.63g/L,P<0.05)。化疗不良反应情况,治疗组骨髓抑制发生率明显低于对照组(38.0%vs70.0%,P<0.05)。恶心呕吐发生率也明显低于对照组,且有统计学意义(22.0%vs52.0%,P<0.05)。治疗组院内感染发生率明显低于对照组(4.0%vs26.0%,P<0.05)。结论肠内联合肠外营养治疗在2周期化疗后可明显改善晚期消化道恶性肿瘤患者的营养状况、生活质量,而且可以有效减轻化疗不良反应,降低院内感染的风险。

Objective To explore the effects of enteral combined parenteral nutrition treatment on the nutritional status, quality of life, chemotherapy toxicity and nosocomial infection for patients with advanced gastrointestinal cancer after two chemotherapy cycles. Methods Totally 100 patients were randomly divided into the treatment group and the control group. The treatment group （n=50） was treated with combined parenteral with enteral nutritional support and chemotherapy, the control group （n=50） was provided with normal diet and chemotherapy. The nutritional status, toxicity reaction, quality of life, and nosocomial infection rate of the two groups were assessed and evaluated before and after each cycle of chemotherapy. Results There were no signifcant differences of the nutritional status, quality of life and nosocomial infection rate between two groups before chemotherapy and after the frst cycle of chemotherapy. After two cycles of chemotherapy, the body mass index （19.59±4.05 vs 18.91±3.36, P〈0.05） and hemoglobin （109.5±7.55g/L vs 103.10±4.63g/L, P〈0.05） were significantly higher than that in first cycle of chemotherapy. The incidence of myelosuppression was signifcantly lower than that in control group （38.0% vs 70.0%, P〈0.05）. There were signifcant difference between nausea and vomiting in treatment group and the control group （22.0% vs 52.0%, P〈0.05）. The incidences of nosocomial infection in the treatment group were lower than in the control group （4.0% vs 26.0%, P〈0.05）. Conclusions Combined parenteral with enteral nutritional therapy after two chemotherapy cycles can not only ameliorate the nutritional status and quality of life of patients with advanced gastrointestinal cancer, but also alleviate the chemotherapy-induced adverse reaction, and prevent nosocomial infection.