个体化营养干预在老年肿瘤患者中的临床应用

Clinical study of individualized nutritional intervention in elderly patients with tumors

目的探索个体化营养干预对老年肿瘤患者的营养、Karnofsky功能状态评分(KPS评分)、生活质量及寿命的影响。方法选取2016年1月—2019年12月于上海交通大学医学院附属新华医院崇明分院肿瘤科住院治疗的老年肿瘤患者100例,采用随机数字表法分为实验组和对照组,每组50例。对照组根据患者的病情、临床症状,参照美国国立综合癌症网络指南及诊疗常规,采取常规的支持治疗及姑息性抗肿瘤治疗,实验组在对照组的基础上增加个体化营养干预措施。个体化营养干预措施包含营养风险筛查及评估,根据筛查结果分别给予营养教育及膳食指导、口服营养补充营养、肠内营养及肠外营养干预。入组时、入组后2个月比较2组患者BMI指数、KPS评分、生活质量评分,入组后6个月时统计入组患者的生存期。结果干预后,2组患者的BMI、KPS评分比较差异有统计学意义(均P<0.05),实验组生活质量评分[(20.75±1.67)分]高于对照组[(18.23±3.19)分,P<0.001]。实验组中位生存期为172.0 d,对照组中位生存期为162.5 d,2组比较差异有统计学意义(P<0.001)。结论个体化营养干预可以延缓老年肿瘤患者的BMI下降、抑制KPS评分下降、限制生活质量下降,延长患者的寿命,值得在临床工作中推广。

Objective To explore the effects of individualized nutrition intervention on nutrition,Karnofsky performance score(KPS),quality of life and life span in elderly cancer patients.Methods A total of 100 elderly cancer patients treated in the Department of Oncology,Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University Medical College from January 2016 to December 2019 were selected and randomly divided into test group and control group,with 50 patients in each group.The control group adopted routine supportive treatment and palliative anti-tumor treatment according to the patient’s condition and clinical symptoms with reference to the national comprehensive cancer network(NCCN)guidelines and the routine diagnosis and treatment.While,the test group carried out individualized nutritional intervention on the basis of the control group.Individualized nutrition intervention measures included nutrition risk screening and evaluation.According to the screening results,nutrition education and dietary guidance,oral nutrition and supplementary nutrition,enteral nutrition and parenteral nutrition intervention were given respectively.BMI,KPS and quality of life score of all patients were checked at the time of enrollment and 2 months after enrollment,and survival time of enrolled patients was calculated at 6 months after enrollment.Results After the intervention,the BMI and KPS scores of the two groups were statistically significant(all P<0.05).The quality of life score of the test group[(20.75±1.67)points]was higher than that of the control group[(18.23±3.19)points,P<0.001].The median survival time was 172.0 days in the test group and 162.5 days in the control group,and the difference between the two groups was statistically significant(P<0.001).Conclusion Individualized nutritional intervention can delay the decline of BMI,inhibit the decline of KPS score,limit the decline of quality of life and extend the life of elderly patients with tumors,which is worth promoting in clinical practice.