肿瘤营养治疗的基本原则

Principles in cancer nutrition therapy

肿瘤营养治疗可以显著改善临床结局、延长生存时间、提高生活质量、节约医疗费用,应该作为肿瘤患者的一线治疗、基础治疗,贯穿于肿瘤治疗的全过程。肿瘤患者应该早期启动全程、主动营养治疗。根据营养诊断结果分类实施营养治疗,遵循膳食优先、口服优先、营养教育优先、肠内营养优先的四个优先原则和营养教育、口服营养补充(ONS)、管饲、部分肠外营养(PPN)及全肠外营养(TPN)五阶梯营养治疗规范。肿瘤营养疗法的基本要求是满足肿瘤患者目标能量及营养素需求,最高目标是调节代谢、控制肿瘤、维护机体功能、提高生活质量、延长生存时间。按照卧床患者20~25 kcal/(kg·d)、活动患者25~30 kcal/(kg·d)计算总能量需求,按照1.2~1.5 g/(kg·d)计算蛋白质供给。根据患者胰岛素抵抗情况,调整葡萄糖、脂肪酸供能比例。荷瘤患者建议降低葡萄糖供能比例、增加脂肪酸供能比例。多种药理营养素联合强化配方对肿瘤患者有正面作用。终末期肿瘤患者的营养治疗要求个体化,充分尊重患者及家属的意见。

Cancer nutrition therapy can significantly improve clinical outcomes prolong survival time improve quality of life and save medical costs.It should be used as the first-line and basic treatment for cancer patients throughout the whole process of treatment.The cancer patients should start the nutrition therapy entirely and actively at an early stage.According to the nutritional diagnosis nutrition therapy should be implemented correspondingly following the four priority principles of dietary priority oral priority nutritional education priority and enteral nutrition priority and the five-step nutrition therapy specification of nutritional education oral nutritional supplements ONS tube feeding partial parenteral nutrition PPN and total parenteral nutrition TPN.The basic requirement of cancer nutrition therapy is to meet the energy and nutrient requirements of cancer patients and the highest goal is to regulate metabolism control cancer maintain body functions improve quality of life and extend survival time.The total energy requirement is assessed using 20-25 kcal/kg·d for bedridden patients and 25-30 kcal/kg·d for active patients and the protein supply is assessed using 1.2-1.5 g/kg·d.The energy supply ratio of glucose and fatty acid should be adjusted in the light of the insulin resistance of patients.It is suggested that tumor-bearing patients should reduce the proportion of glucose and increase fatty acid.The combination of multiple pharmacological nutrients has a positive effect on cancer patients.Nutrition therapy for endstage cancer patients requires individualization and full respect for the opinions of patients and their families.