胃肠外营养支持治疗对肺癌病人化疗后营养状况和免疫功能的影响

目的:探讨胃肠外营养(PN)支持对肺癌病人化疗后康复过程中的临床作用和安全性。方法:将108例肺癌化疗病人随机分为对照组(普通治疗组)和观察组(PN组),通过检测两组病人化疗前后的各项营养指标和免疫指标的变化,对两种治疗方式进行比较。结果:观察组病人化疗前(T0)和第1疗程化疗后(T1)与对照组比各项营养指标和免疫功能指标均无明显变化;第2疗程(T2)至第4疗程化疗后(T4)各项营养指标和免疫功能指标均较对照组明显改善(均P<0.05)。结论:胃肠外营养可有效地改善肺癌病人化疗后机体的营养状况和免疫功能,有利于病人后期的综合治疗。     

消化道恶性肿瘤化疗病人营养状况现况调查和影响因素分析

目的:通过调查消化道恶性肿瘤单纯行化疗病人的营养状态及支持的现况,并分析相关影响因素,为后期制定针对性的营养支持护理方案提供理论依据。方法:选取2019年1月~2019年9月上海长海医院757例消化道恶性肿瘤单纯行化疗的病人为调查对象,运用营养风险筛查2002(NRS 2002)评分表和病人主观整体营养状况评估量表(PG-SGA)进行营养不良分级,对相关影响因素进行分析。结果:757例消化道肿瘤病人中存在营养风险的占35.4%,其中可疑营养不良占19.4%,中度营养不良占54.8%,重度营养不良占25.7%。最近2周体质量变化、有无"无食欲"、"呕吐"、"腹泻"、"疼痛"等症状以及年龄≥65岁是消化道肿瘤化疗病人营养不良的主要影响因素。营养支持现状:87.3%的病人接受营养教育,66.4%接受营养支持,营养支持并发症发生率高。结论:单纯化疗的消化道肿瘤病人营养不良发生率高,化疗后胃肠道不良反应的发生以及营养支持并发症的发生是影响营养状况的主要原因,做好症状管理以及规范营养支持是改善该类病人营养状况的主要方向。     

肠外营养支持对胃癌新辅助化疗病人围术期营养状态和免疫功能的影响

目的:探讨肠外营养(PN)支持对胃癌新辅助化疗病人营养状态和免疫功能的影响。方法:选择局部进展期胃癌病人60例,随机分为PN组和对照组,每组各30例,两组病人均可经口进食。对照组病人经口进食;PN组经口进食+术前化疗期间行PN支持,比较两组病人化疗前后、手术前后的营养状况、免疫功能和术后恢复情况。结果:(1)两组病人化疗2周期后血清清蛋白(ALB)、转铁蛋白(TF)、前清蛋白(PA)呈下降趋势,与化疗前比差异有显著性统计学差异(P0.05),而PN组各指标高于对照组(P0.05)。(2)两组病人化疗2周期后IgA、IgG、IgM、CD4+、CD4+/CD8+呈下降趋势,与化疗前比差异有显著性统计学差异(P0.05),而PN组各指标高于对照组(P0.05)。(3)PN组病人化疗的不良反应少于对照组(P0.05)。(4)术后第7天,PN组病人ALB、TF、PA和IgA、IgG、IgM、CD4+、CD4+/CD8+水平均高于对照组,差异有显著性统计学意义(P0.05)。结论:胃癌新辅助化疗病人在化疗期间给予PN支持有助于提高其化疗期间和术后的营养状态,减少免疫功能损伤和化疗的不良反应。     

胃肠癌肿术后围化疗期肠外营养的临床研究

目的：研究胃肠外营养在胃癌、结肠癌术后围化疗期的临床疗效。方法：80例胃癌、结肠癌术后病人采用自身前后交叉对比的方法随机分为两组。一组为单纯化疗者,另一组在接受化疗的同时给予胃肠外营养,结果：胃肠外营养能增强病人的食欲,改善病人的营养状况,提高机体免疫力,使病人如期接受化疗,组能减轻化疗药物的不良反应。结论：胃肠癌术后围化疗期有必要给予胃肠外营养。     

Parenteral nutrition in cancer therapy: a useful adjunct?

The value of nutritional support during cancer therapy continues to be debated. Data from studies concerned with nutritional rehabilitation of malnourished cancer patients suggest that in certain patient subgroups, total parenteral nutrition may improve tolerance to and increase efficacy of anti-neoplastic treatment modalities. In contrast, other investigators have questioned whether nutritional support of cancer patients may actually benefit the tumor at the expense of the host. Animal tumor model studies indicate that further research is warranted to ascertain whether human host and tumor tissue differentially utilize nutrient substrates and whether these differences may be used to the advantage of the host.     

Parenteral nutrition does not stimulate tumor proliferation in malnourished gastric cancer patients

BACKGROUND: The present study evaluated the effects of preoperative parenteral nutrition (PN) on tumor cell proliferation in malnourished gastric cancer patients. METHODS: Twenty malnourished patients affected by gastric cancer were randomized to receive the standard hospital oral diet (control group) or the standard hospital oral diet plus PN (PN group; 0.2 g/kg/d of nitrogen and 30 nonprotein kcal/kg/d). Samples of tumor tissue and surrounding health mucosa were taken by endoscopic biopsies and from the operative specimen, immediately after resection. Tissues were sent for histologic examination and prepared for flow cytometry and for the measurement of the uptake of bromodeoxyuridine (BduR) by cells after in vitro exposure to the agent. The BduR uptake is largely used to assess the proportion of cells actively synthesizing DNA and is one of the principle methods used to measure tumor proliferation. RESULTS: In the PN group, the mean percentage of tumor cells incorporating BduR was 2.51% +/- 1.7% in the endoscopic samples and 1.52% +/- 0.8% in the operative specimens (p = .2). In the normal mucosa, the mean percentage of cells incorporating BduR was 2.24% +/- 1.8% and 1.13% +/- 1.1%, respectively (p = .1). In the control group, the percentage of cells incorporating BduR in the normal mucosa was 1.26% +/- 1.1% at endoscopy and 0.41% +/- 0.3% at surgery (p = .2), whereas the percentage of cells incorporating BduR in the tumor tissue was 1.41% +/- 1.2% at endoscopy and 0.48% +/- 0.6% at surgery (p = .2). The percentage of S-phase cells documented by flow cytometry in the PN group was: in the tumor, 6.6% +/- 2.9% in the endoscopic samples and 5.7% +/- 2.5% in the operative specimens (p = .6); in the normal mucosa, 5.8% +/- 2.5% at endoscopy and 5.4% +/- 0.9% at surgery (p = .7). In the control group, the percentage of proliferating cells measured by flow cytometry was 4.9% +/- 3.2% in the normal mucosa taken by endoscopic biopsy and 5.3% +/- 1.4% in the normal mucosa taken from the operative specimens (p = .8), whereas it was 11.4% +/- 7.2% in the tumor taken with endoscopic biopsy and 9.7% +/- 4% in the tumor tissue taken from the surgical specimens (p = .7). CONCLUSIONS: The present study suggests that PN does not stimulate tumor proliferation in malnourished patients affected by gastric cancer.     

The value of objective measurements to select patients who are malnourished

Several studies have attempted to define nutritional parameters that can be used to select malnourished hospitalised patients for nutritional support. A combination of objective nutritional parameters was evaluated in a group of 50 patients selected for total parenteral nutrition on clinical grounds only and compared with a control group. This control group consisted of 38 patients who were admitted for elective minor surgical procedures such as varicectomy and hernia repair. On a subset of 18 objective nutritional measurements, discriminant analysis was performed. In the evaluation it was shown that a combination of albumin (ALB), prealbumin (PALB), total lymphocyte count (TLC) and the percentage of ideal weight (PIW) was the most useful combination of nutritional tests in discriminating a chosen malnourished (M) group and a control group who were declared not malnourished (NM). With this combination the patients were correctly classified in 93% with a sensitivity of 93% and a specificity of 94%.     

Nutritional status of mechanically ventilated critically ill patients: comparison of different types of nutritional support

Malnutrition is a common problem in hospitalized patients. Early assessment of nutritional status may help in identifying patients for whom nutritional interventions are needed. The purpose of this study was to assess and compare the nutritional status of mechanically ventilated critically ill patients who were receiving nutritional support. Forty-nine patients were divided into either enteral nutrition, total parenteral nutrition or combined (enteral plus total parenteral nutrition) groups. Anthropometric and biochemical measurements, and medical status (APACHE II score) were assessed at the 1st day and 14th day of admission in the intensive care unit (ICU) of Taichung Veteran General Hospital. The length of ventilator dependency was significantly positively correlated with calorie and carbohydrate intake in the pooled group. Patients receiving enteral and combined nutrition showed significantly lower anthropometric measurements at the 14th day after admission. Patients in all groups had abnormal mean biochemical values at the 1st day of admission. Subjects in the combined group showed a significant increase in prealbumin and the Maastricht Index levels after 14 days. Patients in all three groups were malnourished when admitted to the ICU. Patients showed a slightly improvement of nutritional status after receiving nutritional support for 14 days.     

Influence of total parenteral nutrition on plasma fibronectin in malnourished subjects with or without inflammatory response

Plasma fibronectin, which is an alpha 2-glycoprotein of importance for the immunodefence, has been reported to decrease after starvation and in severely ill patients with cancer. To evaluate the usefulness of fibronectin as an indicator of nutritional repletion, 18 patients with gastrointestinal disorders were studied over a 2-wk period of total parenteral nutrition (TPN). According to nutritional assessment on admission the patients were divided into well nourished (n = 6) and malnourished (n = 12). For comparison nine patients with anorexia nervosa were also studied over a 3-wk period of TPN. Before and after TPN fibronectin, albumin, prealbumin, transferrin, and two acute-phase reactants, haptoglobin and orosomucoid were measured in plasma. The majority of the malnourished patients had an inflammatory reaction in contrast to only a few of the well-nourished and anorexia nervosa patients. Of the proteins measured, only fibronectin rose significantly in the malnourished patients (malnourished and anorexia nervosa), but not in the well nourished patients during TPN. Our results may indicate the usefulness of fibronectin as an indicator of short-term TPN in malnourished subjects, irrespective of the presence or absence of inflammatory response.     

Nutrition au cours des radiothérapies et chimiothérapiesNutritional support during cancer chemotherapy and radiotherapy

Nutritional support for cancer patients treated with radiotherapy and chemotherapy are strongly requested with regard to the frequent malnutrition at time of diagnosis. Furthermore, the malnutrition often progresses with adverse effects of therapy and disease progression. Nutritional screening and assessment are essential. Dietetic care is mandatory for patients with malnutrition or at risk of malnutrition when they are still able to eat. But this oral nutritional support is frequently unable to maintain sufficient nutritional intakes with regard to tumour effect or treatment toxicity. Enteral or parenteral nutrition must be provided to patients unable to absorb adequate quantity of nutrients for a prolonged period. The primary goal is to avoid, especially for malnourished patients, further nutritional degradation which can lead to treatment interruptions, complications or increased risk of death. Routine administration of artificial nutrition has been tested during radiotherapy and chemotherapy but results are conflicting and data are missing for severely malnourished patients. No benefits in terms of treatment toxicity, tumour response, risk of complications and finally mortality have been demonstrated for routine use of artificial nutrition. Most decisions for indication of nutritional support, route of administration and quality of artificial nutrition in this field can't rely today on evidence-based medicine. However, artificial nutrition can provide nutrients and hydration necessary to maintain comfort and to improve survival for patients unable to eat sufficient nutrition for a prolonged period.     

胃肠外营养支持对乳腺癌病人术后营养和免疫功能的影响

目的:探讨胃肠外营养支持在乳腺癌病人术后康复过程中的临床作用和安全性. 方法:将80例乳腺癌手术病人随机分为对照组(行普通治疗)和观察组(行肠外营养支持).通过检测两组病人术前和术后的各项营养指标和免疫指标的变化,对两种治疗方式进行比较. 结果:观察组病人术后第7天各项营养指标和免疫功能指标均较对照组改善,差异有显著性意义(P＜0.05). 结论:胃肠外营养可有效地改善乳腺癌病人术后机体的营养状况和免疫功能,对后期的综合治疗有着重要的临床意义.     

Transferrin--a poor measure of nutritional status

The present study evaluated the sensitivity and specificity of the serum transferrin concentration as a measure of the nutritional state. Serum transferrin was derived from total iron-binding capacity measurements in 74 patients on 114 occasions and correlated with body composition as measured by multiple isotope dilution. Highly significant correlations (p less than 0.001) existed between serum transferrin and both the body cell mass and the nutritional state as measured by the Nae/Ke ratio. However, the 95% confidence limits about both regressions were wide. The false-positive rate was 60% while the false-negative rate was 31%. Body composition and transferrin were measured before and after 2 wk of total parenteral nutrition in 34 malnourished patients. Eighteen patients restored body cell mass toward normal after 2 wk of total parenteral nutrition while in 16 patients the body cell mass continued to decrease in size, despite 2 wk of total parenteral nutrition. The changes in serum transferrin were not significant over this period of time in either group, despite significant changes in the nutritional state in both groups. The presence of a statistically significant relationship between the serum transferrin concentration and the nutritional state indicates that the serum transferrin concentration accurately reflects a population's nutritional status, and is therefore useful in epidemiologic surveys. However, because of the large variance of the data, as demonstrated by the wide 95% confidence limits, and because of the poor sensitivity and specificity, in an individual patient it is of little value as a measure of the nutritional status.     

早期肠内营养和肠外营养支持重型颅脑损伤的效果观察

目的探讨早期营养支持对重型颅脑损伤患者营养状况的效果影响。方法回顾性分析我院2004年1月～2008年10月间收治的重型颅脑损伤患者38例,随机分为肠内营养加肠外营养支持组(观察组)19例和全肠外营养支持组(对照组)19例。观察组早期肠内营养(enteral nutrition,EN)和肠外营养(parenteral nutrition,PN)结合,10天后转为全肠道营养,对照组10天内行全肠外营养支持,观察血糖、血浆白蛋白、淋巴细胞计数,并发症发生率及预后。结果观察组能获得充足的能量和蛋白质合成物,1周时的血糖控制程度、血浆白蛋白及外周血淋巴细胞总数优于对照组(P<0.05),观察组并发症少于对照组。观察组10天后病死率为(15.79%)明显低于对照组(31.58%)。结论重型颅脑损伤行早期肠内营养和肠外营养结合符合病人的病理、生理要求,能使该类病人营养状况和生存率提高。     

Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients

BACKGROUND: About 25-40% of hospital patients are malnourished. With current clinical practices, only 50% of malnourished patients are identified by the medical and nursing staff. OBJECTIVE: The objective of this study was to report the cost and effectiveness of early recognition and treatment of malnourished hospital patients with the use of the Short Nutritional Assessment Questionnaire (SNAQ). DESIGN: The intervention group consisted of 297 patients who were admitted to 2 mixed medical and surgical wards and who received both malnutrition screening at admission and standardized nutritional care. The control group consisted of a comparable group of 291 patients who received the usual hospital clinical care. Outcome measures were weight change, use of supplemental drinks, use of tube feeding, use of parenteral nutrition and in-between meals, number of consultations by the hospital dietitian, and length of hospital stay. RESULTS: The recognition of malnutrition improved from 50% to 80% with the use of the SNAQ malnutrition screening tool during admission to the hospital. The standardized nutritional care protocol added approximately 600 kcal and 12 g protein to the daily intake of malnourished patients. Early screening and treatment of malnourished patients reduced the length of hospital stay in malnourished patients with low handgrip strength (ie, frail patients). To shorten the mean length of hospital stay by 1 d for all malnourished patients, a mean investment of 76 euros (91 US dollars) in nutritional screening and treatment was needed. The incremental costs were comparably low in the whole group and in the subgroup of malnourished patients with low handgrip strength. CONCLUSIONS: Screening with the SNAQ and early standardized nutritional care improves the recognition of malnourished patients and provides the opportunity to start treatment at an early stage of hospitalization. The additional costs of early nutritional care are low, especially in frail malnourished patients.     

Perioperative enteral nutrition and quality of life of severely malnourished head and neck cancer patients: a randomized clinical trial

BACKGROUND AND AIMS: This study evaluated the use of perioperative nutritional support on Quality of Life (QOL) in malnourished head and neck cancer patients undergoing surgery. METHODS: 49 Malnourished (weight loss >10%) head and neck cancer patients who were included in a nutrition intervention trial were randomized to receive either no preoperative and standard postoperative tube-feeding (group I), standard preoperative and postoperative tube-feeding (group II) or arginine-supplemented preoperative and postoperative tube-feeding (group III). Of these patients, 31 completed a full QOL assessment on the first day of preoperative nutritional support, one day before surgery, and 6 months after surgery. Both a disease-specific (EORTC QLQ-C30) and a generic questionnaire (COOP-WONCA) were used. One way analysis of variance (ANOVA) and the Kruskal-Wallis test were applied for testing differences in scores between groups. RESULTS: Between baseline and the day before surgery, both preoperatively fed groups revealed a positive change for the dimensions physical and emotional functioning and dyspnea (with significance in group II, P=0.050,0.031,0.045 respectively). Group III showed a negative change in appetite (P=0.049). Between baseline and 6 months after surgery, there were no differences between group I and both pre-fed groups. There were no differences in favour of group III compared to group II. CONCLUSION: Enteral nutrition improves QOL of severely malnourished head and neck cancer patients in the period preceding surgery. No benefit of preoperative enteral feeding on QOL could be demonstrated 6 months after surgery.     

Significance of hypoalbuminemia in pediatric oncology patients--malnutrition or infection?

Nutritional status was evaluated on 210 occasions in 90 pediatric oncology inpatients during a 7-month period; 39 had solid tumors and 51 leukemia. Ages ranged from 3 months to 20 yr. Nutritional parameters were defined as normal, "at risk," or "probably malnourished." Fifty-seven and 29% of assessments revealed at least one parameter "at risk" or "probably malnourished," respectively. Prognosis was negatively related to the number of abnormal nutritional parameters. Serum albumin was most frequently abnormal. However, on most occasions, hypoalbuminemia was associated with weight/height, arm muscle area, and triceps skinfold measurements in the normal range. In order to further identify determinants of serum albumin, we analyzed dietary, chemotherapy, and temperature data in 10 prospectively studied leukemia patients, half of whom received parenteral nutrition. In these patients there was little relationship of serum albumin to chemotherapy or dietary intake. In all of these patients, especially those receiving total parenteral nutrition, low serum albumin was highly associated with fever (p less than 0.0005). We concluded that febrile illness is an important determinant of abnormal serum albumin concentrations. In pediatric cancer patients, abnormal serum albumin may more often reflect the acute metabolic response to fever and infection than depletion of body mass.     

L-谷氨酰胺联合肠外营养支持对肺癌患者术后免疫和炎症反应的影响

目的研究肺癌根治术后早期应用L-谷氨酰胺联合肠外营养支持对患者营养状况、免疫和炎性反应的影响。方法选择42例行肺癌根治手术的伴有营养不良的肺部恶性肿瘤患者,随机分为试验组（22例）和对照组（20例）。术后第1-5天,每日给予两组患者静脉营养支持,提供非蛋白热卡90KJ·kg^-1·d^-1,氮0．25g·kg^-1·d^-1。术后第2天起,同时给予两组患者流质饮食,试验组患者每日口服L．谷氨酰胺颗粒30g。分别于术前和术后第1、7天抽取静脉血,检测血清白蛋白、前白蛋白、转铁蛋白、T淋巴细胞分化亚群3（CD3）、CD4、CD8、CD4／CD8、免疫球蛋白A（IgA）、IgG、IgM、C反应蛋白,并进行统计学分析。结果术后第7天试验组的血清转铁蛋白[（2．294±0．34）w．‘（2．15±0．42）g／L]、前白蛋白[（0．27±0．76）vs．（0．23±0．84）g／L]、CD4（30．9％±2．2％128．28．9％±2．3％）、CD4／CD8（1．174-0．19vs．1．104±0．81）、IgG1（12．944±2．08）vs.（11．194±1．95）g／LI的水平均显著高于对照组术后第7天的测定值（P均〈0．05）,血清C反应蛋白水平显著低于对照组术后第7天的测定值[（31．6±16．7）vs．（36．54±13．3）mg／L,P〈0．05]。结论肺癌患者术后早期使用L-谷氨酰胺联合肠外营养支持能更好地改善患者的营养状况、免疫功能以及下调机体的急性炎症反应。     

Nutritional support in oncologic patients: where we are and where we are going

The use of nutritional support in cancer patients has evolved since its introduction in the clinical practice 40 years ago. Both parenteral and enteral nutrition are now increasingly integrated within the main oncologic strategy with the aim of making surgery, chemotherapy and radiation therapy more safe and effective. This requires a better awareness of the inherent risk of starvation and undernutrition by the surgeons, medical oncologists and radiologists, the ability to implement a policy of nutritional screening of cancer patients and to propose them the nutritional support in a single bundle together with the oncologic drugs. Four different areas of nutritional intervention are now recognized which parallel the evolutionary trajectory of patients with tumour: the perioperative nutrition in surgical patients, the permissive nutrition in patients receiving chemotherapy and/or radiation therapy and the home parenteral nutrition which may be total (in aphagic-obstructed-incurable patients) or supplemental (in advanced weight-losing anorectic patients). Since cancer is a common disease and the continuous progress in medical therapy is changing its natural history, with more and more patients entering in a chronic and finally incurable phase where nutrition is determinant for survival, we can expect an increased demand for nutritional support in the next future.     

Nutrition en cancérologie : aspects pédiatriquesNutrition and cancer in children

Cancer is associated with a high risk of malnutrition in children. This risk is different from one tumor to another, at the time of diagnosis and at any time of the disease course. Numerous tumor-related and treatment-related factors are involved. High dose-chemotherapy, with its specific side effects is particularly deleterious. Growth curves are of major interest for the long-term follow up of the nutritional status in children. The systematic use of nutritional risk scores is recommended, in order to improve prevention and early treatment of malnutrition. Nutritional supplies should meet the high protein and energy needs associated with cancer and its treatments. Oral and tube-feeding should be used preferably, according to digestive function. Peripheral parenteral nutrition may serve only as a complementary, short-term nutritional support. Central lines are required for all total and/or long term parenteral nutrition periods. Whatever the nutritional support, it can help to fulfil chemotherapy programmes, with benefit on remission duration and survival.     

肠外营养对大肠癌术后早期腹腔内热灌注化疗的价值

目的：探讨肠外在大肠癌术后早期腹腔内热灌注化疗中的临床价值。方法：选择３２例进展期大肠癌病人于术后当天至术后第４天给予ＩＰＨＰ化疗及肠外营养支持,并观察其毒性,并发症,营养指标及免疫功能变化。结果：３２例病人顺利完成治疗而出院,病人毒副反应小,营养及免疫指标明显改善。