肿瘤患者家庭肠内营养治疗的规范化管理

Normalized home enteral nutrition in cancer patients

随着医疗技术发展,肿瘤患者住院时间逐年缩短,越来越多的患者在家庭中接受肠内营养治疗。由于需要营养治疗的患者一般病情比较复杂,如何对需要HEN的患者实施规范化管理,以提高营养治疗效果、减少营养治疗并发症的发生,已成为当前迫切需要研究解决的问题。Pubmed、Embase及CNKI上的国内外HN治疗相关文献,以及我院近年工作经验显示,成立NST团队(含医师、营养师、护师、药师等)并制定相关管理流程和随访制度,不仅减少HEN患者的体重丢失,也利于减少HEN并发症的发生,提高患者满意度。通过营养门诊、电话或APP等方式定期进行营养监测与随访是肿瘤患者全程营养管理的关键步骤,可及时发现并解决患者在HEN过程中遇到的问题,显著提高患者营养治疗的依从性和疗效。由NST团队进行有计划的、重复的和渐进的营养教育和健康管理,并结合专业、有技巧的个体化营养咨询,可以让患者了解营养治疗的目的及意义,促进患者健康行为的养成,提高患者对营养治疗的依从性。NST团队指导下的HEN是肿瘤患者院内营养治疗的延伸,有利于提高营养治疗的有效性和安全性。HEN在发达国家有较好的成本效益,在发展中国家成本效益如何还需要进一步研究。

With the development of medical technology and length of hospital stay reduced home nutrition is widely acceptd by patients.As malnutritional patients are often accompanied with complex clinical condition,some problemes needed to be soved urgently,i.e.,how to implement normalized HEN,which can improve the effect and efficiency of home nutrition,and can reduce the complications of nutritional therapy.By searching literatures related about nutrition therapy through Pubmed,Embase and CNKI,combined with our HN work experiences,results showed that HEN not only reduced weight loss of patients and complications of HEN,but also improved the satisfaction of patients,by establishing NST(including physicians,dieticians,nurses,pharmacists,etc.),making regulations and procedures of nutrition therapy and follow-up.HEN interview through outpatient service,telephone orAPP is the key process of cancer patients'nutrition management,which is beneficial to find and solve the problems timely during the process of HEN,improve patients'compliance and curative effect.Planed,repeated and progressive nutrition education and nutrition management by NST,combined with professional and individualized nutrition counseling,could make patients understand the purpose and significance of nutritional therapy,improve significantly the patient's health behavior and compliance to nutrition therapy.Home nutrition under the guidance of NST is the extension of hospital nutrition therapy,and it’s beneficial to improve the effectiveness and security of nutritional therapy.HEN has been shown good cost effectiveness in developed countries,while in developing countries,more researches need to be done.