胃癌术后出院患者家庭肠内营养使用情况分析

目的 探讨胃癌术后患者营养情况、家庭肠内营养(HEN)使用情况及其现存问题.方法 将124例胃癌根治术患者采用患者提供的主观整体营养状况评价量表(PG-SGA)在出院时及出院4周时进行营养评估,分析患者的HEN使用情况及存在问题.结果 出院4周时,36.3％患者遵循术后少食多餐原则(进食次数≥6次/天),81.5％患者...     

The role of the outpatient clinic in chemotherapy for patients with unresectable or recurrent gastric cancer

BACKGROUND: Recently, outpatient chemotherapy centers have become popular in Japan. To clarify the actual conditions of outpatient clinics, we surveyed entire clinical courses of chemotherapy in patients with unresectable or recurrent gastric cancer. METHODS: From the medical records of 64 patients with unresectable or recurrent gastric cancer with no prior chemotherapy, we obtained data on overall survival, non-hospitalized survival, the number of and reasons for attendance at the outpatient clinic and hospitalization, and medical conditions at discharge. RESULTS: The median follow-up time was 520 days, the median survival time was 353 days, and the median non-hospitalized survival time was 282 days. Patients attended the outpatient clinic 1917 times in total; 145 (8%) of these were unplanned visits for accidental disease, disease progression, or toxicity. Patients were hospitalized 291 times in total: 110 (38%) of hospitalizations were unplanned or emergencies because of disease progression or toxicity. Patients were discharged 290 times in total; in 56 of these discharges (19%) unresolved medical problems remained, such as toxicity, total parenteral nutrition, or symptoms related to cancer. Three patients (5%) died from treatment-related leucopenia and thrombocytopenia. CONCLUSIONS: Patients with unresectable and recurrent gastric cancer were treated at outpatient clinics for periods up to 80% longer than the entire clinical course of chemotherapy. However, there were some unplanned or emergency hospitalizations and some patients still experienced medical problems at discharge. The role of the outpatient clinic is very important to chemotherapy for patients with unresectable or recurrent gastric cancer.     

晚期肿瘤患者家庭肠内营养治疗进展

营养不良为肿瘤患者最常见的并发症及致死因素,在晚期肿瘤患者中更为多见。由于住院时间缩短,治疗方式及目标改变,越来越多的患者选择在家庭中接受营养治疗,合理、有效地家庭营养治疗对改善晚期肿瘤患者的预后及生活质量具有积极作用,其中家庭肠内营养由于简便、安全成为晚期肿瘤患者家庭营养治疗首选的应用方式。规范的家庭肠内营养能够有效降低患者营养不良的发生率,不仅有助于改善和维持患者营养状况,提高生活质量,而且能够满足其生理、心理需要,避免了长期住院,有利于节省医疗费用,有明显的社会效益。然而,家庭肠内营养实施目前仍面临着多方面的挑战,包括肠内喂养装置、肠内营养配方组分、实践创新、医疗保障等。目前亟待探索规范、安全、可靠的管理实施方式来实现家庭肠内营养治疗,为建立规范的晚期肿瘤患者的家庭肠内营养模式提供思路。     

肠内营养对胃食管癌化疗患者营养状况及毒副反应的影响

目的 探讨肠内营养治疗对胃食管癌化疗患者营养状况、免疫功能以及化疗毒副反应的影响。方法  连续采集 2017 年 1 月至2018 年 1 月安徽省肿瘤医院肿瘤内科接受化疗的胃食管癌化疗患者,随机分为肠内营养组和常规饮食组, 根据患者进食梗阻程度、营养结构和进食量不同给予营养治疗,同时肠内营养组患者在化疗开始前两天至化疗结束后 1 周 给予肠内营养制剂。监测两组患者的营养状态、生化指标、免疫水平及化疗后血液系统和胃肠道毒副反应等。结果 共 56 例患者入组,其中肠内营养组29 例,常规饮食组27 例,男 36 例,女 20 例。两组患者资料无明显差异,肠内营养组患者 营养状态明显改善,白细胞、血清白蛋白、血红蛋白及 CD4+/CD8+ 水平显著提高（P ＜ 0.05）。肠内营养组3~4 度血液系 统毒副反应明显减轻（P ＜ 0.05）。消化道反应的发生率,两组患者无明显差异（P ＞ 0.05）。结论 胃食管癌患者化疗期 间接受肠内营养治疗可以改善患者营养状态、提升免疫水平和减少化疗毒副反应,有助于提高患者生存质量。但由于病例 数较少,需进一步扩大研究。     

The prospects of the outpatient clinic or home anti-cancer chemotherapy for unresectable recurrence of colorectal cancer

In this study, we analyzed the effectiveness of anti-cancer chemotherapy at the outpatient clinic. We administered CDDP 5 mg/day every 5 days for a week with continuous systemic chemotherapy by 5-FU 500 mg/day for 3 weeks in the hospital, and in the outpatient clinic CDDP 5 mg/day every two days for a week with UFT 300 mg/day orally every day to 145 patients with unresectable recurrence of colorectal cancer. The 50% survival duration after beginning of this chemotherapy was 310.0 days. One-year and 2-year survival rates were 44.4% and 11.7%. One hundred and nine cases were evaluated. The total response rate was 19.3%, and the highest response rate was seen in metastatic lymph nodes (37.5%). The mean duration of continuation of this chemotherapy and the mean duration of staying at home was 188.2 days and 237.8 days. The mean rate of home stays was 68.6%. The group of performance status (PS) 0 or improving PS, accounted for 74.5% of all cases. The occurrence rate of adverse effects was as follows; stomatitis: 17.9%, diarrhea: 11.7% and bone marrow suppression: 13.1%. However, the occurrence rate for cases of grade 3 or 4 was only 1-4%. According to these results, this was an excellent chemotherapy to maintain the patient's QOL from the outpatient clinic.     

新辅助化疗联合肠内营养治疗胃癌伴幽门梗阻的疗效分析

目的:探讨胃癌伴幽门梗阻患者在肠内营养支持下同时予以新辅助化疗的疗效。方法:回顾性分析2016年6月至2018年6月在中国医科大学肿瘤医院诊断为胃癌伴幽门梗阻80名患者的临床资料。结果:80名患者中37名患者术前实施鼻空肠营养管肠内营养支持联合新辅助化疗（实验组）,43名患者入院后直接手术治疗（对照组）。实验组患者术前1天的营养指标:前白蛋白、白蛋白、淋巴细胞计数均明显优于初次入院,且和对照组相比,在术前1天、术后第2、5天、术后1月的营养指标有统计学差异;在术后并发症方面,仅在术后低白蛋白上有统计学差异,余未体现统计学差异;实验组在根治性切除率、术后恢复情况均优于对照组。结论:新辅助化疗联合肠内营养支持能改善患者的营养状态、提高根治性切除率、缩短住院时间。     

胃癌患者全胃切除术后家庭肠内营养可行性研究

目的探讨胃癌全胃切除术后日常家庭肠内营养的可行性。方法将南京鼓楼医院集团宿迁市人民医院2013年2月至2015年10月收治的40例全胃切除术患者,按抽签分组法分为试验组20例(患者出院后仍保留鼻空肠营养管4周)和对照组20例(患者出院时即拔除鼻空肠营养管)。观察患者出院后4周的营养摄入量、营养参数、生活质量和医疗费用。结果出院后4周,对照组患者体重下降较试验组更多,试验组患者右手握力大于对照组,且血浆总蛋白、血红蛋白含量高于对照组,差异有统计学意义(均P0.05);两组上臂肌围、血浆白蛋白相比,差异无统计学意义(均P0.05)。EORTC QLQ-C30生活质量量表评分显示,试验组的整体健康状态、情绪功能优于对照组,症状量表中试验组患者恶心呕吐及疲劳症状均小于对照组(均P0.05);但在腹泻及医疗费用中,试验组高于对照组(均P0.05);两组患者躯体功能、睡眠障碍相比,差异无统计学意义(P0.05)。结论胃癌患者全胃切除术后实施家庭肠内营养不仅能改善营养状况、提高生活质量,而且安全简便,不良反应发生率低,安全可行。     

Improvements in patient satisfaction at an outpatient clinic for patients with breast cancer

The present study prospectively investigated changes in patient satisfaction at an outpatient clinic for patients with breast cancer. Consecutive patients were asked to anonymously complete a questionnaire after their medical examination. The questionnaire consisted of 12 multiple-choice items concerning waiting time, interpersonal skills of physician and nurse, continuity of care, length of medical visit, communication and expectations. Finally, patients were asked for suggestions for improvements at the clinic in an open-ended question. The first measurement was conducted in 2000/2001 and the last in 2004, and between the two points of assessments efforts to develop care were introduced. Statistically significant improvements were found in eight of the 12 items: waiting time, length of medical visit, information, expectations and continuity of care. In conclusion, the questionnaire captured positive changes in patient satisfaction between the two measurements. Further changes for the better were still requested concerning continuity of care despite reported improvement.     

The future of chemotherapy at home--from outpatient chemotherapy to chemotherapy at home

Chemotherapy for colorectal cancer has changed greatly. A continuous systemic chemotherapy like FOLFOX or FOLFIRI became a standard. It is necessary to get sufficient knowledge and technique of chemotherapy for an infusion port system and a portable pump system. The risk management aspect is very important. Both strict and steady drug mixing and an administration system are necessary. It is also important to make a 24-hour surveillance system for any unusual conditions. The hospital as a whole must come to grips with these problems. The chemotherapy at an outpatient clinic or home will become a standard in the near future because it preserves the patients' QOL.     

胃癌术后患者早期肠内营养支持的临床价值

目的：探讨胃癌术后早期肠内营养支持的时机、安全性、可行性。方法：将51例胃癌胃大部切除手术患者随机分为肠内营养组（EN组,n=26）和肠外营养组（PN组,n=25）。肠内营养组（EN组）采用术中放置十二指肠营养管及胃肠减压管,术后12小时开始进行肠内营养。肠外营养组（PN组）采用术中仅放置胃肠减压管,术后常规＂三升袋＂静脉高营养。两组分别监测术后第1天、第10天患者的血清白蛋白、血清前白蛋白、血红蛋白、免疫球蛋白（A、G、M）、白细胞总数、早期胃肠道恢复时间、住院时间及平均住院费用等指标。结果：EN组术后血清白蛋白、血清前白蛋白、免疫球蛋白G水平较PN组恢复迅速,两者间有显著差异（P〈0.05）。EN组术后肛门排气排便时间较PN组缩短。EN组在缩短术后住院时间与减少住院费用方面也较PN组具有优势,差异显著（P〈0.01）。结论：胃癌术后早期肠内营养支持在时机上是安全、恰当、可行的,对改善术后早期机体营养状态具有显著作用,同时明显促进胃肠功能恢复,减少了患者住院时间与费用。     

肠内营养干预对晚期胃癌患者化疗后生活质量和营养指标的影响

目的探讨肠内营养干预对晚期胃癌患者化疗后生活质量和营养指标的影响。方法选取2016年1月至2017年6月间上海市静安区中心医院收治的80例行奥沙利铂+替吉奥(OT方案)化疗的晚期胃癌患者,采用随机数表法分为观察组和对照组,每组40例。观察组患者采用肠内营养干预,对照组患者采用常规干预,比较两组患者化疗前后生活质量和营养指标。结果化疗后,两组患者躯体功能、角色功能、情绪功能、认知功能和社会功能评分均较化疗前降低,且观察组患者各项评分均高于对照组,差异均有统计学意义(均P <0. 05)。化疗后,观察组患者体质量指数、右上臂周围、左上臂周围水平及血清血红蛋白、白蛋白、前白蛋白和转铁蛋白含量均较化疗前升高,对照组患者以上指标均降低,观察组患者各指标均高于对照组,差异均有统计学意义(均P <0. 05)。结论肠内营养干预对晚期胃癌患者化疗后生活质量和营养状态均有改善价值。     

谷氨酰胺强化肠内营养对晚期胃癌患者免疫功能及营养指标的影响

目的 探讨谷氨酰胺强化肠内营养对晚期胃癌患者免疫功能及营养状况的影响.方法 回顾性分析142例晚期胃癌患者的临床资料,根据营养支持方案的不同将患者分为对照组和观察组,每组71例.对照组患者采用肠内营养混悬液(TPF)作为常规营养支持,观察组患者采用富含谷氨酰胺的TPF作为强化营养支持.观察并比较治疗前后两组患者的营养指标、胃肠激素水平、免疫功能和生活质量.结果 治疗前,两组患者的营养指标、胃肠激素水平、免疫功能、生活质量比较,差异均无统计学意义(P﹥0.05).治疗后,观察组患者的营养指标均高于对照组患者(P﹤0.05).治疗后,观察组患者的胃肠激素水平和免疫指标均明显高于对照组患者(P﹤0.01).治疗后,观察组患者的生活质量高于对照组患者(P﹤0.05).观察组患者的1年生存率为84.5％(60/71),明显高于对照组患者的56.3％(40/71)(P﹤0.01).结论 以谷氨酰胺为主的强化营养支持可改善患者的免疫功能和营养状况,具有良好的临床应用价值.     

益生菌联合麦芽糊精果糖肠内营养对胃癌患者术后的影响

目的 研究添加益生菌联合麦芽糊精果糖肠内营养对胃癌患者术后恢复情况及主观舒适度、腹胀发生情况的影响.方法 研究对象采用徐州医科大学附属连云港医院2016年6月至2019年6月收治的择期手术胃癌患者120例,采用随机数字表分为两组,分别为对照组和试验组,每组患者60例,两组患者均进行胃癌D2根治术,手术后两组患者均采取S...     

胃癌手术患者肠内营养治疗及肠道微生态调节的研究进展

胃癌是全球范围内发病率第5位、死亡率第3位的恶性肿瘤;对于有手术机会的胃癌患者主要的治疗方案仍是手术切除,由于胃癌患者精神心理因素、肿瘤消耗、机械梗阻、分解代谢增加等因素会导致患者严重的营养代谢问题,继而影响手术的安全性以及术后康复。外科手术是胃癌最主要的治疗方式,但由手术带来的创伤、生理结构的改变,以及术后的化疗则进一步加重上述问题。肠道微生态是人体免疫功能等重要组成部分,而现有研究提示肿瘤代谢、外科手术、化疗等均可能造成肠道菌群的改变。随着加速康复外科理念的发展,胃癌的综合治疗越来越为外科医生所重视。如何改善患者胃癌术后身体营养状况、减轻肠道菌群紊乱,进而减少术后并发症、加快术后康复,已成为胃肠外科医生关注的重点。本文主要通过文献回顾对行胃癌患者围术期肠内营养治疗及肠道微生态调节的应用进行综述。     

Standards, Options and Recommendations for home parenteral or enteral nutrition in adult cancer patients]

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for home parenteral or enteral nutrition in adult cancer patients. METHODS: Data were identified by searching Medline, Cancerlit, web sites and using the personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to 72 independent reviewers. RESULTS: The main recommendations for home parenteral or enteral nutrition in adult cancer patients are: 1) Home parenteral or enteral nutrition concerns cancer patients with malnutrition or with inadequate/impossible oral intake, during therapy of because of therapeutic after-effects (standard). Same indications apply for home and hospital artificial nutrition (standard). 2) Patients need a multidisciplinary follow-up (oncologists, nutritionists, and pain specialists), and this follow-up will make treatment adaptations according to the nutritional status possible (recommendation, expert agreement). An active participation of patients and/or their family circle is very important (standard). 3) The benefit of home parenteral or enteral nutrition on the quality of life of terminally ill patients (vs. hydration) has not been demonstrated. When life expectancy is below 3 months, and the Karnofsky index below 50, the drawbacks of home artificial nutrition are more important than its advantages. In this case, home parenteral or enteral nutrition is not recommended (recommendation, expert agreement). 4) Prospective clinical trials are recommended to evaluate the impact of home nutrition on quality of life in cancer patients (expert agreement). 5) The use of educational booklets that mention the telephone number of a referent health care and what to do when a problem happens (e.g. fever on home parenteral nutrition) is recommended (expert agreement). In France, patients should be referred to authorized home parenteral nutrition centres (recommendation, expert agreement).     

胃癌术后早期肠内营养的临床应用

目的探讨胃癌术后早期肠内营养的可行性、安全性和临床效果。方法选取2011年1月至2013年12月收治的138例胃癌患者,采用随机数字表法分为全胃肠外营养组(TPN组,67例)和肠内营养组(EN组,71例),分别观察两组患者术前、术后3 d、术后7 d的体重、红细胞、淋巴细胞、血红蛋白、白蛋白、总蛋白等指标,并观察胃肠道功能恢复情况及各种不良反应。结果所有患者均无死亡,无严重并发症。TNP组及EN组手术前后各指标无明显变化,但EN组排气时间、排便时间和营养治疗费用较TPN组明显缩短,差异有统计学意义(P<0.05)。结论胃癌术后早期肠内营养安全、可行,在改善机体营养状态方面具有与传统全胃肠外营养支持相似的效应,并能促进和加快胃肠道功能早期恢复,同时降低费用。     

Consideration of cancer home chemotherapy with cooperation between hospital and clinic

Recently, the progress in chemotherapy has brought an improvement in the survival rate of patients with non-resectable digestive tract cancer. Simultaneously, maintenance of patients' QOL is regarded as important. In our hospital, we use low-dose FP therapy to maintain QOL and a satisfactory survival rate. To date, we have administered low-dose FP to more than 50 patients with non-resectable digestive cancer. We investigated patients who received home chemotherapy after being evaluated NC, and found no remarkable side effects as a result of this therapy during admission.     

Second-line chemotherapy for patients with advanced gastric cancer

The first choice for treating patients with metastatic gastric cancer is chemotherapy, and combination therapy with fluorouracil, platinum, and trastuzumab has been established as the standard first-line chemotherapy. For further improvement of treatment outcomes, it is important to develop second- and third-line chemotherapy. In the first decade of this century, irinotecan and taxanes, cytotoxic agents, and various molecular targeted agents began to be developed as second-line therapy. Treatment with paclitaxcel weekly in combination with ramucirumab targeting vascular endothelial growth factor receptor 2 has become the first choice for second-line therapy. Immune checkpoint inhibitors are now being developed, and the current treatment strategies for advanced gastric cancer may undergo major changes in the future. This review summarizes the transitions and future prospects of clinical developments for second-line therapy in patients with advanced gastric cancer.     

恶性肿瘤放射治疗患者肠内营养专家共识

所有恶性肿瘤放疗患者均应进行营养不良三级诊断,包括营养筛查、营养评估和综合测定。营养风险筛查推荐 采用NRS 2002 量表,营养评估推荐采用PG-SGA 量表。不推荐对恶性肿瘤放疗患者常规进行营养治疗。临床医师应该综 合评估患者的营养状况（PG-SGA评分）及放疗过程中急性放射损伤（RTOG 分级）,筛选出具备营养治疗适应证的患者, 选择合理的营养治疗路径,及时给予营养治疗。恶性肿瘤放疗患者的营养治疗采用五阶梯治疗原则,肠内营养途径的选择 采用四阶梯原则。不推荐放疗前预防性置入营养管,除非患者存在以下一种或多种情况：明显体重丢失（1 个月内大于5% 或者6 个月内大于10%）、BMI 小于18.5、严重吞咽梗阻或疼痛、严重厌食、脱水、预期将发生严重放射性口腔或食道黏 膜炎。恶性肿瘤放疗患者能量摄入推荐量为25~30kcal/(kg·d),但应在放疗过程中根据肿瘤负荷、应激状态和急性放射损伤 动态调整。恶性肿瘤放疗患者应该减少碳水化合物在总能量中的供能比例,提高蛋白质、脂肪的供能比例。谷氨酰胺对 降低放射性皮肤毒性、放射性黏膜炎的发生率和严重程度有益处,ω-3 PUFA 有利于提高放疗患者免疫功能,调节机体炎性 反应,建议在肠内营养配方中加入。在恶性肿瘤放疗患者肠内营养过程中,医师应该根据不同观察指标的反应快慢对肠内 营养的疗效和不良反应进行定期评价。患者出院后,如果仍存在经口摄入营养不足或营养管依赖的情况,应该给予家庭肠 内营养治疗和管理。