鼻空肠营养治疗对食管癌放疗患者疗效和不良反应的影响

Nasojejunal nutrition therapy improves the efficacy and decreased adverse reactions of radiotherapy for esophageal cancer patients

目的探讨中晚期食管癌患者放疗期间不同营养治疗方式对其近期疗效和不良反应的影响。方法根据不同的营养干预途径,将134例有高危因素的中晚期食管癌患者分为试验组及对照组。试验组(n=67)给予鼻空肠营养管饲治疗,对照组(n=67)给予膳食指导、口服营养补充或肠外营养治疗。对比两组患者近期疗效、不良反应发生率和治疗完成率,并分析管饲相关不良事件。结果两组患者一般资料均衡可比。试验组放疗有效率高于对照组,但无统计学差异(P>0.05)。试验组消化道出血、3级以上放射性食管炎发生率均显著低于对照组(P<0.05),但3级以上骨髓抑制、2级以上放射性肺炎发生率较对照组无差异(P>0.05)。试验组治疗完成率高于对照组(P<0.05)。试验组放疗期间、放疗后1月体重丢失均明显低于对照组(P<0.05)。试验组所有患者于放疗结束后1月内拔除空肠营养管,共4例患者(5.97%)出现食管返流、误吸与吸入性肺炎,并未影响原有治疗计划。结论在对有高危因素的中晚期食管癌患者行胸部放疗时,鼻空肠管饲营养治疗有助于维持患者体重、降低不良反应、减少治疗中断。

Objective To evaluate the effects of different nutritional support methods on short-term efficacy and adverse reactions of patients with advanced esophageal cancer during radiotherapy.Methods According to nutritional intervention,patients were divided into the experimental group and the control group.The experimental group(n=67)was given nasojejunal nutrition tube feeding,while the control group(n=67)was given dietary guidance,oral nutrition or parenteral nutrition.Short-term efficacy,incidence of adverse reactions and treatment completion were compared between the two groups,and nutrition-related adverse events were analyzed.Results The two sets of data were comparable and balanced.The effective rate of radiotherapy in the experimental group was higher than that in the control group,but there was no statistical difference(P>0.05).The incidence of gastrointestinal bleeding grade 3 or above radioactive esophagitis in the experimental group was significantly lower than that in the control group(P<0.05),but there was no difference in the incidence of grade 3 or above bone marrow suppression and grade 2 or above radioactive pneumonia(P>0.05).The treatment completion rate of the experimental group was higher than that of the control group(P<0.05).Weight loss at the end of radiotherapy and 1month after radiotherapy were significantly lower in the experimental group than those in the control group(P<0.05).All patients in the experimental group were removed from the jejunal nutrition tube within 1month after the end of radiotherapy.5.97%of the patients developed esophageal reflux,aspiration and aspiration pneumonia,without affecting the original treatment plan.Conclusion When patients with advanced esophageal cancer and high risk factors were treated with chest radiotherapy,nutritional support by tube feeding help to maintain body weight,reduce adverse reactions,and reduce treatment interruption.