恶性肠梗阻的营养治疗策略

Strategies for nutritional treatment of malignant bowel obstruction

恶性肠梗阻是晚期肿瘤患者频发的终末期事件,常伴随重度营养不良和恶液质,严重影响患者治疗疗效和生存质量。合理的肠外肠内营养治疗可以使恶性肠梗阻患者的肠道功能得到一定程度恢复,水、电解质、酸碱平衡紊乱得到纠正,一般状况得到明显好转,从而获得再次姑息性手术或者造瘘的机会,提高生活质量。因此,开展规范化的营养治疗对恶性肠梗阻患者具有重要意义。然而,迄今为止,尚无专门针对恶性肠梗阻患者的营养治疗策略。因此,本文拟通过对恶性肠梗阻患者营养治疗最新国内外文献的全面检索与分析,从恶性肠梗阻患者的营养诊断、营养治疗肠内肠外营养治疗适应证、治疗途径、治疗通路、营养素和疗效评价六个方面分别进行证据论述和意见推荐,以期指导临床营养的治疗。

Malignant bowel obstruction(MBO)that incite considerable distress for patients and their families was a common pre-terminal event for patients with advanced cancer.Reasonable nutritional treatment,including parenteral and enteral nutrition,might recover the intestinal function of MBO patients,correct the disturbance of internal environment,and significantly improve the general condition,so as to obtain the opportunity of palliative surgery or fistula,thereby improving the quality of life.Therefore,the standardized nutrition therapy strategy is of great significance to patients with MBO.However,to date,there are no guidelines for nutritional treatment for MBO patients.Therefore,this paper searched and analyzed the latest literature on nutritional treatment of MBO.After repeated discussions and modifications,we developed this nutrition therapy strategy.The guideline discussed the evidence and recommendations from the six aspects of nutrition diagnosis,nutritional treatment indications,treatment access,treatment pathways,nutrients,and efficacy evaluations for patients with malignant bowel obstruction.It has certain guiding significance for the treatment of clinical nutrition.