早期肠内营养支持对44例口腔口咽癌术后放化疗患者的影响

Effect of early enteral nutritional support on 44 patients with postoperative chemoradiotherapy for oral and oropharyngeal cancers

目的:探讨放疗前2周进行肠内营养支持治疗对口腔口咽癌患者术后放化疗的营养状况及生活质量的影响。方法:回顾性分析44例口腔口咽癌术后放化疗患者在不同时机进行营养干预后的营养状况及生活质量变化。将放疗前2周体重作为协变量,校正基线水平后,对观察指标体重、体质指数(BMI)及其与基线的变化值、主观整体营养状况评估(PG-SGA)等及生活质量评分量表(EORTC QLQ-C30及QLQ-H&N35)中整体健康状况、躯体功能和疲劳感3个方面分别进行评估。采用SPSS 19.0软件包,以重复测量方差分析分别对观察指标进行统计学分析。结果:早期干预(即放疗开始前2周至放疗结束后2周给予肠内营养补充)25例,按需干预(即放疗3周后至放疗结束后2周给予肠内营养补充)19例。2组体重在放化疗期间整体均呈下降趋势,但早期干预组的下降程度更小(P=0.023)。2组PG-SGA在观察期间均出现较大幅度下降,早期干预组更显著(P=0.027)。2组整体健康状况总体上均好转,但患者均出现不同程度的疲劳感,躯体功能也不断下降,按需干预组更明显(P>0.05)。2组在放射性口腔黏膜炎程度分级上无统计学差异。结论:口腔口咽癌患者术后放化疗期间的营养状况明显下降,早期肠内营养支持可在一定程度上维持体重,改善患者营养状况,但在提高患者生活质量方面未见明显优势。

PURPOSE:To investigate the effects of enteral nutritional support on nutritional status and quality of life of patients with postoperative chemoradiotherapy for oral and oropharyngeal cancer 2 weeks before radiotherapy.METHODS:This study retrospectively analyzed the nutritional status and life quality of 44 patients with oral and oropharyngeal cancer,who were nutritionally intervened at different times with postoperative chemoradiotherapy.Based on the weight 2 weeks prior to radiotherapy as a covariate to correct the baseline,weight,body mass index,as well as their changes from baseline,and patients'generated-subjective global assessment,global health status,physical function and fatigue in the quality of life questionnaire(EORTC QLQ-C30&H&N35)were evaluated.SPSS 19.0 software package was used for repeated measurement analysis of variance.RESULTS:The total number of early intervention(2 weeks before radiotherapy to 2 weeks after the end of radiotherapy)was 25 and reactive intervention(3 weeks after radiotherapy to 2 weeks after the end of radiotherapy)was 19.The weight of both groups showed a downward trend during the chemoradiotherapy period,but the degree in the early intervention group was significantly smaller(P=0.023).PG-SGA of both groups showed signifi-cant decrease during the follow-up period,especially that in the early intervention group(P=0.027).The global health status of two groups was overall improved,but patients in both groups experienced fatigue,and their physical function continued fading,especially those in reactive intervention group(P>0.05).There was no significant difference in the grades of oral mucositis between two groups.CONCLUSIONS:The nutritional status of patients with oral and oropharyngeal cancer undergoing postoperative chemoradiotherapy decreased significantly.Early enteral nutritional support can sustain weight and improve patients'nutritional status to some extent,but fails to enhance the quality of life of patients.