口服营养补充的指南更新

Updated guideline for oral nutritional supplements

肿瘤患者营养不良发生率高,营养治疗作为一线治疗对于肿瘤患者十分必要且应贯穿治疗的全周期。口服营养补充作为人工营养中肠内营养的重要手段之一,在临床应用广泛,但是仍有很多临床使用的细节问题尚不明确。本文以2018年及以后的ESPEN、ASPEN、CSPEN营养指南为参照,检索pubmed、中国学术期刊网络出版总库、万方数据期刊论文资源自2017年1月1日至2022年10月31日的随机对照试验、专家共识、meta分析和系统评价,检索式为“口服营养补充”“营养治疗”“营养干预”“肠内营养治疗”“特殊医学用途配方食品”,根据检索结果进行文献精读,同时扩大检索阅读至参考文献。对使用ONS可获益的肿瘤类型、不同部位和病理种类的肿瘤患者使用ONS的使用方法、使用剂量、不同肿瘤患者的适宜配方、是否需要额外添加免疫增强营养素等治疗细节证据进行更新,并采用GRADE方法进行证据分级,为进一步指导临床工作者实践中合理使用营养制剂进行口服营养补充治疗提供理论依据。

The incidence of malnutrition in tumor patients is high. As a first-line treatment, nutritional therapy is very necessary for tumor patients, which should be run through the whole treatment cycle. Oral nutritional supplements, as one of the important means of enteral nutrition in artificial nutrition, is widely used in clinical practice, with still many details of clinical use unclear. Based on the 2018 and later-on ESPEN, ASPEN and CSPEN nutrition guidelines, this paper searches the pubmed, CAJD and Wanfang data from January 1st, 2017 to October 31st, 2022 for randomized controlled clinical trials, expert consensus, Meta-analysis and systematic. The search free words are " oral nutrition supplement" " nutrition treatment" " nutrition intervention" " enteral nutrition treatment" and "formula food for special medical purposes". The authors carried out literature reading according to the search results,and expanded the search to the references. This paper updated the detailed evidence reporting patients with different tumor pathological types who can benefit from the use of ONS, especially the method, the dosage of ONS, as well as the appropriate formula for different tumor, and additional immune enhancing nutrients. The authors used GRADE method to evaluate the evidence, so as to provide a theoretical basis for further clinical practice for oral nutritional supplements.