肝癌患者的医学营养治疗

肝癌是我国常见恶性肿瘤,肝癌患者的营养不良发生率较高,影响其首次住院时营养状态主要原因是肝损害程度和荷瘤状态,肝切除手术、放疗、化疗,以及靶向治疗等抗肿瘤治疗措施均可进一步加重肝功能损伤和恶化营养状态,医学营养干预是肝癌治疗的重要组成部分。肝癌患者的医学营养治疗的规范化诊疗步骤包括:“筛查、评定、干预”,通过营养风险筛查(如营养风险筛查2002)确定需要接受营养治疗的患者;通过患者主观整体评估(PG-SGA)等方法诊断营养不良,通过实验室检查和Child-Pugh分级评定肝脏功能等;根据肝癌患者的代谢能力和机体需求确定能量与蛋白质供给目标;有营养风险或营养不良的肝癌患者首选口服营养补充,对肠内营养不能满足60%能量供给或不能接受肠内营养者,适时给予补充性肠外营养,以期达到维持营养状态,提高抗肿瘤治疗依从性,改善临床预后的目的;肝癌患者合并的肝功能异常可导致多种微量元素和维生素的缺乏,适时适量补充微营养素对肝癌患者提升营养状态和维护肝功能有积极意义。

Medical nutritional therapy for patients with liver cancer

Liver cancer is a common malignant tumor in China.The incidence of malnutrition is high in patients with liver cancer,the main reasons affecting their nutritional status at the time of the first hospitalization are the degree of liver damage and the tumor-burdened state.The anti-tumor treatment measures such as liver resection,radiotherapy,chemotherapy and targeted therapy can further aggravate the liver function injury and worsen the nutritional status.Medical nutrition intervention is an important part of the treatment of liver cancer.The standardized diagnosis and treatment procedures for the medical nutrition treatment of liver cancer patients include:“screening,assessment,and intervention”.Nutritional risk screening(e.g.,nutritional risk screening 2002)is used to identify patients requiring nutritional treatment.Malnutrition was diagnosed by means of patient-generated subjective nutrition assessment(PG-SGA)and liver function was assessed by laboratory examination and Child-Pugh classification grading.Energy and protein supply targets are determined according to the metabolic capacity and body demand of liver cancer patients.Oral nutritional supplement is the first choice for liver cancer patients with nutritional risk or malnutrition.For those who cannot meet 60%of the energy supply of enteral nutrition or cannot accept enteral nutrition,supplemental parenteral nutrition should be given timely to maintain nutritional status,improve he compliance of anti-tumor treatment and improve clinical prognosis.Abnormal liver function in patients with liver cancer can lead to the deficiency of various trace elements and vitamins,timely and appropriate supplementation of micronutrients has positive significance for improving nutritional status and maintaining liver function in patients with liver cancer.