肿瘤放化疗患者营养状况及营养支持分析

目的:调查分析肿瘤放化疗患者营养风险、营养不足发生率及营养支持情况。方法:以2017年1月至10月肿瘤放化疗患者为研究对象,采用营养风险筛查表（NRS2002）筛查营养风险和营养不足,暂无营养风险者,每周重复筛查。比较不同年龄和不同肿瘤类别患者间营养风险和营养不足的差异。调查患者的营养支持状况和营养支持方式,比较不同营养风险患者间营养支持率的差异。结果:符合标准的369名患者中,营养风险和营养不足发生率分别为45.3%、30.6%。不同年龄患者间营养风险和营养不足发生率差异有统计学意义（P<0.05）。不同肿瘤类别患者间营养风险和营养不足发生率差异有统计学意义（P<0.05）。营养支持率39.8%,其中肠外、肠内、肠外+肠内营养支持占比分别为97.3%、0%、2.7%,肠外营养支持的患者中全合一和单瓶输注占比分别为59.9%、40.1%。不同营养风险患者间营养支持率差异有统计学意义（P<0.05）。结论:肿瘤放化疗患者营养风险发生率较高,但营养支持率较低,且营养支持存在不合理性,规范化营养风险筛查和营养支持值得进一步推广。     

食管癌患者术前营养不足和营养风险发生率及临床营养支持现状调查

目的:调查可手术食管癌患者术前营养不足和营养风险发生率以及临床营养支持治疗的应用状况。方法:采用营养风险筛查2002(NRS2002)对住院手术治疗的202例食管癌患者进行营养风险调查,结合体质指数(body mass in-dex,BMI)判断营养风险和营养不足发生率;同时调查患者住院期间营养支持治疗的应用状况。结果:所有患者中,BMI<18.5kg/m2者54例,营养不足发生率为26.7%(54/202);NRS2002评分≥3分者116例,营养风险发生率为57.4%(116/202);年龄是否>65岁(χ2值分别为6.233、4.730)、术后分期(χ2值分别为7.214、7.191)、梗阻程度(χ2值分别为41.507、51.447)、文化程度(χ2值分别为5.158、10.260)是发生营养不良和营养风险的影响因素,P<0.05。城乡差异和工作性质只与营养不足发生率有关,χ2值分别为6.537、9.197,P值分别为0.011、0.010;而与营养风险发生率无关,χ2值分别为0.300、3.668,P值分别为0.584、0.160;营养不足和营养风险与食管癌发生的部位无关,χ2值分别为2.859、4.551,P值分别为0.239、0.103。经Logistic回归分析后发现,术后分期、梗阻程度和文化程度是营养不足和营养风险发生的影响因素。全部患者中,应用了营养支持治疗者137例(72.3%),其中采用肠内营养支持治疗(enteral nutrition,EN)者48例(35.0%),肠外营养支持治疗(parenteral nutrition,PN)者89例(65.0%),EN/PN为1/1.85;EN在术后28～72h,平均为术后56h;在NRS2002评分≥3分的116例患者中,给予营养支持治疗98例(84.5%),而在NRS2002评分<3分的86例患者中,也有39例(45.3%)给予了营养支持治疗。结论:食管癌手术患者营养不足和营养风险发生率较高,营养支持治疗在临床应用中还存在一定的不合理性。     

张瑞萍，高云阁，董晓昕，周学慧，王志高，崔庆超，翟树森

目的：调查127例住院患者的营养风险、营养不足发生情况及营养支持治疗现状,分析营养风险的发生与病期、年龄、血红蛋白、白蛋白及前白蛋白的关系。方法：对127例患者,于入院第2天采用营养风险筛查量表（nutrition risk screening 2002,NRS2002）进行营养风险及营养不足评估。并记录患者年龄、身高、体重、病期、血红蛋白、白蛋白、前白蛋白及患者的治疗情况,计算患者的体重指数（body mass index,BMI）及NRS2002评分。明确患者的年龄、病期、血红蛋白、白蛋白、前白蛋白与营养风险的关系。结果：127例恶性肿瘤患者营养不足（BMI ＜18．5kg／m2）25例,占19．69％;具有营养风险的患者（即 NRS2000评分≥3分者）为72例,发生率为56．69％。23例给予营养治疗,其中3例 NRS2002评分为1～2分,≥3分以上患者给予营养支持治疗20例（5例为终末期患者）,占27．78％,主要应用脂肪乳、氨基酸及葡萄糖治疗。年龄越大,发生营养风险的几率越高,贫血、白蛋白及前白蛋白水平降低增加营养风险的发生率,病期的早晚与营养风险无相关性。结论：肿瘤患者营养风险发生率高,营养支持治疗未得到重视,存在不恰当及不充分的营养支持治疗。积极纠正贫血及低蛋白血症是营养支持治疗的重要补充。     

营养风险筛查对胃癌手术并发症发生率的预测价值*

目的:探讨营养风险筛查对胃癌手术后并发症发生率的预测价值。方法:对2013 年1 月至2014 年10 月新疆医科大学附属肿瘤医院胃肠外科择期行胃癌根治术的353 例胃癌患者,采用欧洲营养风险筛查2002 （NRS 2002 ）评分进行术前营养评估,比较存在营养风险的患者和无营养风险的患者术后并发症发生率。结果:按照 NRS 2002 评分,术前存在营养风险和无营养风险者术后并发症发生率分别为47 .0%（77 /164）和31 .2%（59 /189）,差异有统计学意义（P=0.002）。NRS 2002 评分≥3 分的患者,术前有营养支持比无营养支持并发症发生率低,差异有统计学意义（P=0.013）。经Logistic多因素风险回归分析证实,NRS 2002 评分是胃癌手术后并发症的独立危险因素（P=0.039,0R=1.634,95 % CI :1.025～2.606）。结论:NRS 2002 评分作为一种术前营养风险筛查方法,可有效预测胃癌手术后并发症的发生率。      

恶性肿瘤住院患者营养风险和营养不足发生率及营养支持应用状况调查

[目的]调查恶性肿瘤住院患者营养风险和营养不足发生率及营养支持应用状况。[方法]自2010年8月至2011年1月间,连续选择符合研究方案要求的恶性肿瘤住院患者687例,均获知情同意。在入院后48h,采用营养风险筛查2002（NRS-2002）调查营养风险和营养不足发生率。在入院后14d或出院时调查营养支持应用状况。[结果]恶性肿瘤住院患者营养不足发生率为26.35%,营养风险发生率为45.56%。老年（≥65岁）恶性肿瘤患者营养风险发生率显著高于中青年患者（58.02%vs38.74%,P=0.001）。有营养风险患者（NRS-2002≥3）中,146例（46.65%）接受了营养支持,无营养风险（NRS-2002〈3）患者中64例（17.11%）接受了营养支持。肠外与肠内营养的比例平均为6.99：1。[结论]大量恶性肿瘤住院患者存在营养风险或营养不足。肿瘤患者肠外和肠内营养应用存在不合理性,需要基于证据的营养支持指南以改善此状况。     

晚期肿瘤患者营养风险及影响因素的研究

目的:探讨晚期肿瘤患者的营养风险及可能的影响因素。方法:收集2018年1月到2020年6月我院肿瘤内科收治的94例晚期肿瘤患者的临床资料，采用KPS评分评估患者的体力状况，采用营养风险筛查量表（NRS2002）筛查患者的营养风险，采用疼痛视觉模拟评分法(VAS)评估患者的疼痛程度，分析患者的营养风险情况及其可能的影响因素。结果:94例晚期肿瘤患者中有营养风险的患者(NRS2002评分≥3分的患者)共53例，占56.4%；年龄＞70岁患者共34例，有营养风险患者占70.6%，与年龄≤70岁患者具有显著统计学差异；KPS评分≤60分患者有37例，有73.0%患者存在营养风险，与KPS＞60分患者有显著统计学差异；不同BMI指数及疼痛程度的患者间有显著的统计学差异。消化系统肿瘤共有59例，有营养风险者占43例，总营养风险发生率达72.9%(43/59)。结论:晚期肿瘤患者营养风险的发生率较高，消化道肿瘤更显著，年龄、KPS评分、BMI指数、疼痛是其重要的影响因素。     

胃癌患者82例营养风险筛查及相关因素分析

摘 要： ［目的］ 应用欧洲营养筛查方法(NRS 2002) 分析胃癌患者营养风险。［方法］ 收集胃癌患者82例,患者入院48h进行营养风险筛查,采用NRS2002评估表进行评分。NRS2002总分≥3分为存在营养风险。［结果］ 在82例住院胃癌患者中,NRS 2002 营养风险筛查评分为(2.51±1.08)分,NRS2002≥3分24例,营养风险发生率为29.3%。随着患者临床分期的升高,营养风险发生率随之升高,Ⅰ期患者营养风险发生率为5.9%,而Ⅳ期患者的营养风险发生率为57.1%。营养风险发生率与患者的年龄、居住地和医疗费用相关。营养不良者（BMI＜18.5kg/m2）发生营养风险发生率为100%,但25.9%（14/54）患者的BMI 虽处于正常范围仍存在营养风险。NRS 2002≥3分存在营养风险的患者平均住院天数为(14.4±9.2)d,明显长于NRS 2002＜3分无营养风险的患者的(9.0±4.8)d (P＝0.041)。［结论］ NRS2002 对住院患者营养风险和营养支持率的调查可有效鉴别住院患者的营养风险,并为营养支持提供依据。     

放射治疗中心恶性肿瘤患者营养状况的横断面调查研究

目的调查恶性肿瘤放射治疗住院患者的营养风险和营养不良发生率。方法选取2017年8月至2017年10月就诊于重庆大学附属肿瘤医院放射治疗中心的恶性肿瘤患者330例为研究对象,采用连续定点抽样调查的方法,对患者进行NRS 2002、PS-SGA、人体测量指标和实验室检测等数据收集。结果330例患者完成营养调查,其中,男性227例,女性103例（68.8% vs 31.2%）,年龄（54.0±11.4）岁,有营养风险（NRS 2002≥3分）发生率为28.8%,营养不良（PG-SGA ≥4分）发生率为52.7%,鼻咽癌患者营养风险检出率最高为（29.3%）,其次为肺癌（28.1%）、口腔癌（18.1%）和食管癌（15.2%）。BMI与PG-SGA评分呈负相关,NRS 2002评分与PG-SGA评分呈正相关。年龄（≥65岁）、白蛋白（<40g/L）、 前白蛋白（<150g/L）、卡氏功能状态评分（<80分）是营养风险和重度营养不良的危险因素（P<0.05）。结论放射治疗中心的恶性肿瘤患者营养风险发生率属于中等水平,营养不良发生率较高,建议加强放疗患者的营养管理,结合患者的营养状况,PG-SGA评分可作为营养干预的参考标准。     

营养风险筛查工具NRS-2002评估食管癌放疗患者营养状况的价值

目的 用营养风险筛查工具NRS-2002评价食管癌放疗患者营养状态,同时评价NRS-2002在这群中的应用价值。方法 回顾分析2010—2014年在浙江省肿瘤医院确诊为食管癌并接受放疗的 97例患者资料。Kaplan-Meier法计算生存率并Logrank检验差异,Pearson法分析NRS-2002评分与血液指标的相关性,Cox模型多因素预后分析。结果 27%患者在放疗前就存在营养风险,这种风险随放疗进行而逐渐升高。入院时NRS-2002评分≤3分、≥4分的 1年OS分别为91%、62%(P=0.010)。治疗期间NRS-2002评分最高分≤2分、≥3分的 1年OS分别为94%、78%(P=0.012),最低分≤3分、≥4分的 1年OS分别为91%、55%(P=0.018)。入院时、放疗第1周NRS-2002评分与前白蛋白有关(P=0.000、0.002),放疗第3周NRS-2002评分与白蛋白有关(P=0.036)。多因素分析发现食管癌TNM分期、治疗期间NRS-2002评分最高分是预后影响因素(P=0.001、0.005)。结论 食管癌放疗患者存在较高营养风险,NRS-2002评分可提示食管癌放疗患者的预后,可作为营养风险初筛工具。     

局部晚期鼻咽癌患者营养状况及其与预后相关性分析

目的:探讨局部晚期鼻咽癌患者营养状况及其与预后相关性。方法:分析2015年8月至2017年3月湖北省肿瘤医院收治的局部晚期鼻咽癌住院患者53例,联合运用患者主观整体营养评估量表(patient-generated subjective global assessment,PGSGA)、体格测量、血液学指标和放化疗不良反应,全面评估患者营养状况;采用Kaplan-Meier法及Cox风险比例回归模型对患者生存及影响因素进行分析。结果:53例患者中,94.3%(50/53)的患者出现体质量下降,下降均值为(6.89±0.54)kg,50.9%(27/53)的患者体质量下降≥10%;PG-SGA评估的患者重度营养不良发生率为84.9%(45/53);淋巴细胞计数、红细胞、血红蛋白、白蛋白与PG-SGA评分高度负相关(P<0.05),口腔黏膜炎、吞咽困难或疼痛、厌食、体质量下降百分比与PG-SGA评分高度正相关(P<0.05);单因素及多因素分析显示,TNM分期晚、治疗期间体质量下降≥10%与局部晚期鼻咽癌患者预后不良相关,而白细胞计数增加(在正常值范围内)与局部晚期鼻咽癌患者预后良好相关,差异均具有统计学意义(P=0.036,P=0.016,P=0.024)。结论:局部晚期鼻咽癌患者营养不良发生率高;PG-SGA评分联合体格测量、血液学指标和放化疗不良反应,能够更全面地评估患者营养状况;TNM分期晚、治疗期间体质量下降≥10%是局部晚期鼻咽癌患者预后的不良因素,而白细胞计数增加(在正常值范围内)是患者预后的有利因素。     

Concurrent chemoradiotherapy combined with enteral nutrition support: a radical treatment strategy for esophageal squamous cell carcinoma patients with malignant fistulae

Background:Concurrent chemoradiotherapy (CCRT) significantly increases the survival rate of esophageal squamous cell carcinoma (ESCC) patients with malignant fistulae.Recent clinical evidence has shown the benefits of enteral nutrition for malnourished cancer patients.In this study,we aimed to validate that,with the support of enteral nutrition,ESCC patients who develop malignant fistulae might be able to complete CCRT and achieve long-term survival.Methods:We reviewed the medical records of 652 patients with ESCC who received definitive CCRT at Sun Yat-sen University Cancer Center between January 2010 and December 2012.Treatment outcome and toxicity were retrospectively evaluated in 40 ESCC patients with malignant fistulae.All the 40 patients were treated with CCRT and evaluated by clinical nutritionists using nutrition risk screening (NRS) before,during,and after treatment.Twenty-two patients received a nasogastric tube,and 18 underwent percutaneous endoscopic gastrostomy feeding.The median energy intake was 2166 kcal/day.Treatment response was evaluated at 3 months after the completion of CCRT.Results:With a median follow-up of 18 months (range,3-39 months),patients' 1-year overall survival (OS) rate was 62.5％,and the estimated OS time was 25.5 months.Univariate analysis showed that the NRS score (P =0.003),increase in NRS score (P =0.024),fistula closure (P =0.011),and response to treatment (P ＜ 0.001) were significantly associated with OS.Multivariate analysis showed that tumor response (P =0.044) and increase in NRS score (P =0.044) were independent predictors of OS.Grade 3 vomiting was observed in 8 patients (20.0％),grade 3 neutropenia was observed in 11 patients (27.5％),and grade 3 cough was observed in 13 patients (32.5％);2 patients (5.0％) died of massive bleeding during treatment.Conclusions:CCRT combined with enteral nutrition support is effective for ESCC patients with malignant fistulae.Patients have an increased potential to be cured,especially those who experience complete response and have an increase in NRS score.Careful observation and nutrition support are required for patients with advanced T-category ESCC who undergo CCRT.     

直肠癌同步放化疗患者营养状态与放化疗不良反应相关性分析

目的 分析直肠癌同步放化疗患者营养状态与放化疗近期不良反应的相关性。方法 收集2018-2019年间浙江省肿瘤医院收治的115例行同步放化疗的直肠癌患者,同时采用欧洲营养风险筛查工具(NRS 2002)和患者主观整体评估量表(PG-SGA)评估患者放疗期间的营养风险状况,采用美国RTOG及不良反应常见术语标准评估急性放化疗不良反应。Spearman′s分析营养状态与放化疗急性不良反应相关性。结果 从放化疗开始前到放化疗第4周患者的营养风险呈逐步增加趋势,随后营养风险又逐步下降。NRS 2002评分和PG-SGA评分均与直肠癌放化疗患者血液学不良反应(r=0.26,P<0.05;r=0.31,P<0.01)、上消化道反应(r=0.51,P<0.01;r=0.63,P<0.01)、下消化道反应(r=0.23,P<0.05;r=0.45,P<0.01)、疲劳(r=0.47,P<0.01;r=0.64,P<0.01)均呈正相关,并且PG-SGA和不同不良反应之间的相关性系数大于NRS 2002。分层分析显示Ⅱ-ⅢB期、<65岁及术后辅助放化疗患者,营养状况和不良反应程度显著相关(均P<0.05)。结论 直肠癌患者同步放化疗期间存在较高的营养不良风险,营养不良风险越高患者放化疗急性不良反应通常越大,建议加强直肠癌放化疗期间的动态营养评估及支持。     

Correlation between nutritional status and toxicity of concurrent chemoradiotherapy in patients with rectal cancer

Objective To analyze the correlation between nutritional status and acute toxicity induced by concurrent chemoradiotherapy in patients with rectal cancer. Methods A total of 115 patients with rectal cancer who underwent concurrent chemoradiotherapy in Zhejiang Cancer Hospital from March 2018 to August 2019 were prospectively selected. Nutritional risk was assessed by NRS 2002 and PG-SGA nutritional screening tools before, during and after radiotherapy. The acute toxicity was assessed by RTOG and CTCAE 3.0 scoring criteria. The correlation between nutritional status and the acute toxicity of chemoradiotherapy was analyzed by Spearman′s correlation analysis. Results The nutritional risk of the cohort was gradually increased from the beginning of chemoradiotherapy to the fourth week of chemoradiotherapy, and then decreased gradually. Spearman′s correlation analysis showed that NRS 2002 and PG-SGA scores were positively correlated with acute hematological toxicity (r=0.26, P<0.05;r=0.31, P<0.01), upper gastrointestinal toxicity (r=0.51, P<0.01;r=0.63, P<0.01), proctitis (r=0.23, P<0.05;r=0.45, P<0.01) and fatigue (r=0.47, P<0.01;r=0.64, P<0.01) in patients with rectal cancer undergoing chemoradiotherapy. The correlation coefficients between PG-SGA and various toxicities were higher than those of NRS 2002. Stratified analysis showed that patients with stage Ⅱ-Ⅲ B, age<65 years and postoperative adjuvant chemoradiotherapy, nutritional status was significantly associated with the severity of toxicity (all P<0.05). Conclusions Patients with rectal cancer has a high risk of malnutrition during concurrent chemoradiotherapy. The higher the risk of malnutrition, the greater the acute toxicity of chemoradiotherapy. Therefore, dynamic nutrition assessment and nutritional support should be strengthened for rectal cancer patients during chemoradiotherapy.     

Évaluation d’un score prédictif de dénutrition chez les patients pris en charge par irradiation pour un cancer des voies aérodigestives supérieures : étude rétrospective chez 127 patients

PurposeThe purpose of this study was to establish a pre-therapeutic score that could predict which patients would be at high risk of enteral tube feeding during (chemo)-radiotherapy for head and neck cancer.Patients and methodsA monocentric study was conducted retrospectively on patients receiving a radiotherapy or concurrent chemoradiotherapy for a head and neck cancer. A logistic model was performed in order to assess clinical or therapeutic risk factors for required artificial nutrition during treatment. Significant parameters, issued from multivariate analysis, were summed and weighted in a score aiming at estimating a malnutrition risk during radiotherapy.ResultsAmong the 127 evaluated patients, 59 patients required artificial nutrition during radiotherapy. In multivariate analysis, predictive factors for malnutrition were weight loss superior to 5% in the 3 months before radiotherapy, advanced tumor stage (III–IV vs. I–II), and pain requiring strong analgesics (step II–III vs. I). Concurrent chemotherapy was identified as a significant risk factor also, but it was strongly correlated with the tumor stage. The score, estimated from these previous factors, allowed a prediction of a risk of enteral feeding with a sensitivity of 90% and a specificity of 85%.ConclusionA predictive score of enteral nutrition before radiotherapy of head and neck cancer should be a useful clinical tool to target the patients who would need a prophylactic gastrostomy. Our study evidenced some risk factors of malnutrition requiring artificial feeding. However, we need a prospective study to confirm the validity of this score.     

Glasgow prognostic score after concurrent chemoradiotherapy is a prognostic factor in advanced head and neck cancer

Objective:This study aims to evaluate the impact and potential prognostic roles of the pre-and post-treatment Glasgow prognostic score (GPS) and the change thereof in patients with advanced head and neck cancer undergoing concurrent chemoradiotherapy (CCRT).Methods:We collected GPS and clinicopathological data of 139 stage Ⅲ,ⅣA,and ⅣB head and neck cancer patients who underwent CCRT between 2008 and 2011.Their GPSs pre-and post-CCRT and the change thereof were analyzed for correlations with recurrence and survival.Results:The GPS changed in 72 (51.8％) patients,with worse scores observed post-CCRT in 65 (90.3％) of the GPS changed patients.Patients in the improved GPS group showed a tendency toward better survival.From the multivariate analysis,the post-CCRT GPS level was an independent prognostic factor in addition to tumor stage.Conclusions:After CCRT,a high GPS was revealed to be an important predictor of survival for advanced head and neck cancer.     

淮安地区食管癌患者ABO血型的相关性研究

目的:调查淮安市食管癌患者ABO血型分布特点,分析其相关性并探讨各种血型物质在食管癌发生中的作用。方法:收集我院初治的食管癌患者263例为病例组,随机抽取淮安市中心血站同时期1000例健康献血人群ABO血型资料为对照组。统计分析两组ABO血型分布频率,进行相关性分析和血型的相对危险率分析。结果:病例组A型血占27.4%,对照组为17.8%,A型血频率在病例组与对照组之间存在显著性差异。病例组B型血、O型血和AB型血型分别占31.6%、30.0%、11.0%,对照组分别占35.7%、36.2%、10.3%,均无显著性差异。相对危险率A型血者为1.54,B型血者为0.89,O型血者为0.83,AB型血者为1.06。结论:淮安ABO血型分布与食管癌的发生具有一定的关系,提示血型物质A抗原可能是食管癌的一个危险因子。     

结直肠癌加速康复外科中的营养风险筛查和营养治疗研究

目的 探讨加速康复外科中,营养风险筛查2002在结直肠癌患者围术期营养变化中的评估作用,并观察其临床应用效果及对此类患者营养治疗的指导意义。方法 根据定点连续抽样法选取2018年4月至2019年4月新入院、未经放化疗处理的围术期结直肠癌患者189例,入院24h和出院24h内均完成营养风险筛查2002。记录患者临床资料、进行人体物理指标测量和血红蛋白、血清白蛋白、前白蛋白的实验室检查,记录患者在住院期间营养治疗的应用状况,根据营养风险筛查 2002结果比较术前行与未行营养治疗患者及相关营养指标、术后康复情况。结果 所有患者全部完成营养风险筛查2002评估,动态营养风险筛查工具适用率高达100.00%。营养风险筛查结果显示,189例结直肠癌患者中,92例（48.68%）术前存在营养风险,其中30例术前给予营养治疗的患者术后康复情况优于术前未接受营养治疗的62例患者。本次研究患者术后营养治疗率为100%,其中肠内营养治疗应用比例较高。入院时营养筛查评分≥3分无营养治疗患者和入院时营养风险筛查 2002评分<3分患者在出院时的白蛋白、前白蛋白水平明显低于入院时。结论 术前营养风险筛查提示结直肠肿瘤患者入院时营养风险发生率较高,术前接受营养治疗可在一定程度上对术后康复有益,围术期过程中应及时合理予以营养治疗,改善患者预后。出院时患者营养风险有增加趋向,应重视患者出院时的营养风险筛查和评估。     

高乌甲素联合奥施康定治疗中重度癌痛的临床观察

目的:探讨高乌甲素联合奥施康定治疗中重度癌痛的疗效及安全性。方法:将50例患者随机分为两组,实验组(25例)接受奥施康定+高乌甲素治疗,对照组(25例)接受奥施康定治疗。实验组中高乌甲素片的用法为10mg tid,与奥施康定同日开始服用。实验组和对照组中都使用奥施康定止痛,以10mg每12h为开始计量,按照数字评分进行剂量调整,达到 NRS≤3分,直到用药结束,观察用药7d后两组的镇痛疗效及不良反应。结果:实验组与对照组所有患者在用药7d内疼痛明显缓解。实验组使用高剂量奥施康定人数比例为16％,而对照组为48％,实验组高剂量人群比例低于对照组,差异有统计学意义(P＜0.05)。实验组与对照组排便困难发生率分别为12％和40％,对照组的排便困难发生率高于实验组的患者,两组的差异有统计意义(P＜0.05)。但两组在呕吐、呼吸困难、尿潴留、眩晕等不良反应方面差异均无统计学意义(P＞0.05)。结论:高乌甲素联合奥施康定可以控制中重度癌痛;联合用药显著减少了高剂量奥施康定使用的人数,高乌甲素增加了止痛效果,减少了排便困难的发生率;奥施康定联合高乌甲素止痛治疗作为中重度癌痛的一种较好的理想选择。     

局部晚期鼻咽癌同期调强放化疗联合辅助化疗的临床疗效

目的观察同期调强放射治疗联合辅助化疗对局部晚期鼻咽癌的临床疗效和不良反应。方法初治局部晚期鼻咽癌患者49例,按92福州分期Ⅲ期30例,ⅣA期19例。鼻咽和上颈部靶体积采用IMRT技术照射,下颈部和锁骨上靶体积采用下颈前切野常规照射。调强放疗设鼻咽大体肿瘤为GTVnx、颈部阳性淋巴结GTVnd、高危临床靶体积CTV1和低危临床靶体积CTV2。处方剂量分别为GTVnx 73.9Gy/33次、GTVnd及CTV166Gy/33次、CTV2(504~594)Gy/(28~33)次。按EORTC或RTOG标准评价急性反应。全组患者均给与同期化疗,放疗结束予3周期辅助化疗。结果中位随访28月,1、2年局部控制率100％,97．96％,1、2年总生存率(OS) 均为97．96％,1、2年无远处转移生存率95.92％、93.89％。结论局部晚期鼻咽癌同期调强放化疗联合辅助化疗可获得较理想的局部区域控率和总生存率。3~4级急性黏膜炎和3～4级血液系统不良反应是化疗的剂量限制性因素。     

The outcome and prognostic factors in patients with aspiration pneumonia during concurrent chemoradiotherapy for head and neck cancer

CHEN S.‐W., YANG S.‐N., LIANG J.‐A. & LIN F.‐J. (2010) European Journal of Cancer Care 19 , 631–635 The outcome and prognostic factors in patients with aspiration pneumonia during concurrent chemoradiotherapy for head and neck cancer This study aimed to investigate the outcome in patients with aspiration pneumonia during definitive concurrent chemoradiotherapy for head and neck cancer. The data of 595 patients with head and neck cancer treated by chemoradiotherapy were reviewed. Forty‐one patients were identified as developing symptomatic aspiration pneumonia during treatment and were analysed for this study. The definition of symptomatic aspiration pneumonia fit three criteria: (1) at least one event of aspiration during the treatment or evidence of grade 2 or above dysphagia during treatment; (2) clinical or radiographic signs of pneumonia or pneumonitis; and (3) no evidence of grade 4 haematological toxicity before the outbreak of pneumonia. Termination of allocated radiotherapy was noted in 10 patients. A treatment break was observed in 26 patients, whereas irradiation was prolonged more than 1 week in 11 patients. Logistic regression analysis showed the dysphagia score during the treatment course and the chest roentgenography pattern following symptomatic aspiration pneumonia were found to independently influence the outcome. Aspiration pneumonia occurring during chemoradiotherapy for head and neck cancer has a detrimental effect on the treatment outcome. Intensive medical care is essential for this group of patients with a dysphagia score of 3 during treatment and an unfavourable chest film pattern.