肺癌患者的营养治疗专家共识

Expert consensus on nutritional treatment for patients with gastroparesis

肺癌是常见肿瘤之一,受摄入减少、手术和靶向药物的影响,营养不良在肺癌患者中很常见。肺癌患者应通过营养风险筛查2002与患者主观整体评估进行营养评估。并非所有接受化疗的肿瘤患者都需要营养治疗,对于营养状况良好的接受化疗的肺癌患者,不推荐常规应用营养治疗。肿瘤患者的蛋白质合成和分解代谢均存在异常。对于进展期肺癌患者,蛋白质分解大于合成,代谢应激因素也会增加蛋白质的需要量,肺癌患者蛋白质需要量推荐给予1.2~2.0 g/(kg·d),能量摄入目标量推荐为25~30 kcal/(kg·d)。口服营养补充是肺癌患者首选的营养治疗方式,适用于能够吞咽、胃肠道功能正常的患者。对于肠内营养可达到正常营养需要量的肺癌患者,不推荐常规进行肠外营养治疗。当患者无法通过肠内营养(如严重放射性食管炎、严重恶心呕吐)获得足够的营养需要时,则应选择补充性肠外营养或全肠外营养。口服谷氨酰胺可降低肺癌患者放射性食管黏膜炎的发生率和严重程度。选用低糖高脂配方可改善慢性阻塞性肺疾病患者血气分析和呼吸功能指标。

Lung cancer is one of the most common tumors.Manutrition is common in patients with lung cancer,which is affected by reduced intake,surgery and targeted dnugs.They should receive nutritional asessment through Nutrtional Risk Screening 2002 and patient-generated subjecive global asessment.Not all cancer patients receiving chemotherapy need nutritional therapy,and routine use of nutritional therapy is not recommended for lung cancer patients receiving chemotherapy with good nutritional status.Protein synthesis and catabolism are abnomal in tumor patients.For advanced lung cancer patients,protein deomposition is greater than synthesis,and metabolic stress factors will also increase the protein requirement.The protein requirement of lung cancer patients is recommended tobe 1.2~2.0g/(kg·d),and the tanget energy intake is recommended to be 25~30 keal/(kg.d).Oral nutritinal supplement is the prefered nutritional therapy for lung cancer patients,suitable for patients who can swallow and have normal gastrointestinal function.For lung cancer patients whose enteral nutrition can meet the normal nutritional requirements,routine parenteral nutrition therapy is not recommended.When patients cannot meet their nutritional needs through enteral nutrition(e.g,severe radiation esophagitis,severe nausea and vomiting),supplementary parenteral nutrition or total parenteral nutrition should be selected.Oral glutamine can reduce the incidence and severity of radioactive esophageal mucositis in lung cancer patients.Low sugar and high fat formula can improve blood gas analysis and respiratory function indexes in patients with chronie obstructive pulmonary disease.