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。     

肺癌手术病人营养风险及对临床结局的影响

目的:评估肺癌手术病人的营养风险,评定营养风险对临床结局的影响。方法:前瞻性评估130例拟诊肺癌手术病人,利用欧洲营养风险筛查2002(NRS2002)作营养风险筛查工具,测定病人体质指数、血清清蛋白水平等营养指标判断营养状况,并观察病人术后并发症和住院时间等指标。结果:肺癌手术病人营养不良和营养风险发生率分别为13.8%和15.4%,并发症的发生率为4.6%,平均住院4.52 d。营养不良和有营养风险的病人平均术后住院时间明显延长。结论:可行手术的肺癌病人营养不良和营养风险发生率较低。术前存在营养不良和有营养风险对术后并发症无影响,但会延长术后住院时间。     

对进展期肿瘤病人整体营养状况筛查的研究

目的:探讨病人整体营养状况主观评估(PG-SGA)表作为进展期肿瘤病人营养状况筛查工具的有效性. 方法:选择择期手术的进展期肿瘤病人88例,利用客观营养指标及PG-SGA表判断其营养状况. 结果:以客观指标判断为营养不良的病人有53例(60.2%),而根据PG-SGA表评估,有54例(61.4%)存在营养不良.PG-SGA表评分的灵敏度达94%,特异性为91%.两种筛查方法有高度的相关性. 结论:PG-SGA表作为进展期肿瘤病人的营养状况筛查,具有简单、有效、易行、无创及快速等优点.     

常见恶性肿瘤住院病人营养状态的调查和分析

目的:调查和分析常见恶性肿瘤病人的营养状态,探讨其与肿瘤临床分期、年龄、各项人体测量和实验室指标的关系. 方法:对220例新人院的恶性肿瘤病人进行相应的人体测量(体重指数、上臂中点周径、三头肌皮皱厚度、上臂肌肉周径)、蛋白质代谢指标检测和卡氏评分,应用PG-SGA进行营养状态评估. 结果:在220例病人中,入院时总体营养不良的发生率为67.3％,消化道恶性肿瘤病人营养不良的发生率为80.5％,高于非消化道肿瘤病人的58.7％ (P ＜0.05).31.8％的恶性肿瘤病人在入院时急需进行营养干预.PG-SGA评分越高,卡氏评分越低,病人活动能力越差.PG-SGA评分与各项人体测量和实验室指标成负相关. 结论:住院的消化道肿瘤病人营养不良发生率高,PG-SGA评分与卡氏评分、各项人体测量和实验室指标呈负相关.     

老年胃癌病人术后早期肠内营养支持的护理

0 引言 临床上老年住院病人营养不良较为常见,国外报道约占20%～60%[1].因为老年人咀嚼功能差、进食少和消化吸收功能减退等原因,容易发生营养不良.特别是患有消化道肿瘤的老年病人,营养不良的程度更为明显.营养支持能提高老年病人的营养状况和免疫功能,促进病人的恢复,改善预后.     

住院老年病人营养不良及其对并发症的影响

目的:了解上海地区住院老年病人营养不良的发生率及其对并发症的影响.方法:采用微型营养评估方法(MNA),结合实验室检查、膳食营养素摄入量、临床并发症,对上海市四所医院60岁以上615例住院老年病人进行调查分析.结果:住院老年病人营养不良平均患病率为20.3%,贫血及低清蛋白血症平均发生率分别为41.5%及57.2%.营养不良病人的能量、蛋白质及大多数微量营养素摄入量显著低于营养状况良好者(P＜0.05),感染及脏器功能衰竭并发症增加.结论:住院老年病人营养不良发生率、贫血、低清蛋白血症患病率较高,营养不良对临床结局有不良影响.     

肿瘤病人口服瑞能疗效观察

0引言 消化道肿瘤特别是中晚期病人,由于肿瘤对全身代谢及消化道本身功能的影响,加上手术创伤、放疗、化疗、生物治疗等的打击,80%以上存在不同程度的营养不良以及器官功能(如免疫功能等)减退.因此,如何改善肿瘤病人营养状况及加强免疫功能有着非常重要的意义.     

鼻咽癌同步放化疗患者发生营养不良的相关影响因素

目的 分析鼻咽癌（NPC）同步放化疗患者发生营养不良的相关影响因素。方法 选取医院2022年1月至2023年2月收治的107例NPC同步放化疗患者为研究对象,收集患者一般资料,采用主观整体营养状况评估量表（PG-SGA）评价患者营养状况,经Logistic回归分析NPC同步放化疗患者发生营养不良的相关影响因素。结果 107例NPC同步放化疗患者中有52例发生营养不良;经Logistic回归分析显示,肿瘤分期Ⅲ-Ⅳ期、消化道症状>3个、味觉障碍、焦虑抑郁、中重度疲乏是NPC同步放化疗患者发生营养不良的影响因素（OR>1,P<0.05）。结论 NPC同步放化疗患者发生营养不良高风险,受肿瘤分期、消化道症状、味觉障碍、焦虑抑郁、疲乏程度影响,可据此制订个体化护理方案,预防营养不良的发生。     

危重症病人C-反应蛋白与营养不良关系的研究

目的:分析危重症病人C-反应蛋白(CRP)与营养不良的关系,为临床判断病情、评估预后、进行治疗提供依据。方法:选取危重症病人140例,于入院后第2天清晨空腹抽取静脉血,测定血清CRP及各项营养指标(总蛋白、清蛋白、血红蛋白、淋巴细胞计数、胆固醇和三酰甘油等),并应用主观全面评价(SGA)法评价病人的营养状况,分析CRP与各项营养指标的关系。结果:①入院病人中营养正常者67例,占47.9%,营养不良者73例,占52.1%;②营养不良组病人CRP明显高于营养正常组(P0.05);③除淋巴细胞计数和血清三酰甘油外,CRP与多项指标均具有明显相关性(P0.05)。结论:危重症病人多存在营养不良,CRP与多项营养指标存在相关性。临床医师可根据病人的CRP水平判断其营养状况,评估病情。     

相位角评估喉癌病人营养状况可行性研究

目的:探讨相位角(PA)评估喉恶性肿瘤病人营养状况的可行性.方法:收集140例喉癌住院病人,术前使用Inbody S 10行人体成分分析、记录PA值,同时进行营养筛查与评估、体格测量与实验室检查.分析PA与营养相关指标的相关性,并以病人主观整体评估(PG-SGA)为营养评价标准,绘制PA的受试者工作特征(ROC)曲线,进而根据截断值分为低PA组与高PA组,计算低PA组营养不良的相对危险度.结果:PA与体质量、BMI、上臂围、上臂肌围、总蛋白、前白蛋白、血红蛋白呈正相关(P＜0.05),与年龄、细胞外水分率(ECW/TBW)呈负相关(P＜0.05);PA的ROC曲线下面积0.71(P＜ 0.01),诊断为营养不良的PA截断值为5.89,灵敏度0.69,特异度0.68,约登指数0.37;低PA组营养不良的比例(71.2％)明显高于高PA组(34.3％),与高PA组相比,低PA组发生营养不良的相对危险度为2.28(95％CI,1.53 ～ 3.41).结论:相位角与喉癌病人的营养状况密切相关,在喉癌病人营养不良的诊断中具有一定的临床应用价值.     

胃肠癌手术前肠外营养支持的免疫作用

通过多项指标评估92例胃肠癌患者的营养和免疫状况，并对9例营养不良者术前行肠外营养支持7～10天。结果表明（1）胃肠癌患者的细胞免疫功能下降；（2）营养不良可加重患者免疫功能的损害；（3）可望通过肠外营养支持，部分改善营养不良胃肠癌患者的免疫状况。     

北京地区消化道恶性肿瘤患者术前营养状态及营养支持应用的回顾性分析

目的调查消化道恶性肿瘤患者术前营养状态及营养支持的应用情况.方法采用回顾性研究,调查2009年4月至12月在北京协和医院接受手术治疗的336例消化道恶性肿瘤患者营养状态和营养支持的应用情况.结果 胃癌患者营养不良发生率最高(34.6％),结直肠癌次之(23.8％),食管贲门癌最低(23％).术前营养状态越差的患者,营养支持使用时间越长,摄入能量越高.结论消化道恶性肿瘤患者存在营养状态下降,目前营养支持的使用不甚合理.     

Malnutrition in Eosinophilic Gastrointestinal Disorders

Primary eosinophilic gastrointestinal disorders (EGIDs) are emerging chronic/remittent inflammatory diseases of unknown etiology, which may involve any part of the gastrointestinal (GI) tract, in the absence of secondary causes of GI eosinophilia. Eosinophilic esophagitis is the prototype of eosinophilic gastrointestinal disorders and is clinically characterized by symptoms related to esophageal inflammation and dysfunction. A few studies have assessed the nutritional status of patients with eosinophilic gastrointestinal disorders, showing conflicting results. This review summarizes the current evidence on the nutritional status of patients with EGIDs, focusing on the pediatric point of view and also speculating potential etiological mechanisms.     

胃肠肿瘤外科患者营养风险及营养支持调查

目的 了解肿瘤专科医院胃肠肿瘤择期手术患者的营养风险及围手术期营养支持情况.方法 采用营养风险筛查2002方法调查我院胃肠外科2010年5至9月新入院胃肠肿瘤择期手术患者的营养风险及围手术期营养支持情况.结果 入院时存在营养风险的患者占43.6％ (85/195),有营养风险的患者术前营养支持率为11.7％ (10/85),术后营养支持率为100％ (85/85).无营养风险的患者术前营养支持率为0,术后营养支持率为84.5％ (93/110).有营养风险与无营养风险的患者术后并发症发生率分别为19.1％ (13/68)和7.1％ (9/127) (P=0.02).结论 胃肠肿瘤择期手术患者营养风险发生率较高,围手术期营养支持不尽合理.入院时存在营养风险的患者术后并发症发生率较高.需要继续推广基于证据的肠外肠内营养指南.     

Comparison of forearm muscle dynamometry with nutritional prognostic index, as a preoperative indicator in cancer patients

We studied 95 patients with cancer of the gastrointestinal tract in various sites. The aim of the study was to compare the forearm dynamometry vs the prognostic nutritional index which was reported by Busby et al, 1890. We used these methods as preoperative prognostic indicators for postoperative mortality and morbidity. The forearm muscle dynamometry has greater positive predictive value (58.33 vs 32.4%), higher sensitivity (77.78 vs 66.6%), and specificity (86.11 vs 65.28%) than the prognostic nutritional index. The forearm muscle dynamometry predicted the patients mortality with a high rate of sensitivity (100%). The results suggest that dynamometry is a useful, rapid, and inexpensive test. It is more accurate than the nutritional index, and can identify cancer patients at a high risk of developing major postoperative complications, and predict the postoperative morbidity and mortality.     

Does perioperative immunonutrition reduce postoperative complications in patients with gastrointestinal cancer undergoing operations?

Perioperative immune modulation using specialized enteral diets containing specific immunonutrients may improve postoperative outcomes in critically ill patients compared with standard formulas. A study from Italy involving 305 patents with histologically confirmed cancer of the gastrointestinal tract undergoing major elective surgery and preoperative weight loss < 10% demonstrated that a specialized preoperative oral formula enriched with arginine, omega-3 fatty acids, and RNA for 5 days before surgery with no nutritional support postoperatively (preoperative group) was as effective as pre- and postoperative administration of the same enriched formula (perioperative group) in decreasing the incidence of postoperative infections and length of hospital stay. Both pre- and perioperative immunonutritional strategies were superior to the conventional approach (no artificial nutrition perioperatively).     

Preoperative nutritional assessment to predict postoperative complication in gastric cancer patients

The correlation between preoperative nutritional parameters and postoperative complications in 440 patients with gastric cancer were analyzed. All the nutritional parameters reflected a significant deterioration as the stages of cancer progressed, and the frequency of postoperative complications was highest in patients with stage IV gastric cancer. The incidence of anastomotic leaks was increased in patients undergoing total gastrectomy with no relation to the clinical stage or nutritional status. However, there was a close relationship between nutritional status and immunocompetence, lung complications, and infection. The nutritional indices which reliably predicted preoperatively the nutritional status of cancer patients were the serum protein concentrations including the serum albumin (Alb) and prealbumin (PA). The indices predicting postoperative complications were the Alb, PA, and total lymphocyte count. These results suggest that preoperative nutritional assessment can be beneficial for the prediction of postoperative complications.     

Association Between Preoperative Nutritional Status and Postoperative Outcome in Head and Neck Cancer Patients

Head and neck cancer patients treated with surgery often experience significant postoperative morbidities. Administering preoperative nutritional intervention may improve surgical outcomes, but there is currently a paucity of data reviewing the association between preoperative nutritional status and postoperative outcome. It is therefore of importance to investigate this association among head and neck cancer patients. To assess the association between preoperative nutritional status and postoperative outcome in head and neck cancer patients treated with surgery, a retrospective study of 70 head and neck cancer patients who were surgically treated between 2013 and 2014 in a tertiary referral head and neck surgery center in Hong Kong was conducted. Clinical data regarding preoperative nutritional status and postoperative outcome were retrieved from a computer record system. Logistic and linear regressions were used to analyze the appropriate parameters. A higher preoperative albumin level was associated with lower rates of postoperative complications and better wound healing (P < 0.05). In contrast, preoperative body mass index, hemoglobin level, and absolute lymphocyte count did not demonstrate significant associations with postoperative outcome. As high albumin levels are associated with better surgical outcome in head and neck cancer patients, preoperative intervention strategies that boost albumin levels could be considered for improving surgical outcome.     

肠内肠外营养对胃肠道肿瘤保守治疗患者生存质量的影响

目的探讨肠内肠外营养对胃肠道肿瘤保守治疗的患者生存质量的影响,以供临床工作参考。方法对我院2008年1月～2010年7月收治的18例保守治疗的胃肠道肿瘤患者,采用营养支持治疗,对比患者治疗前后的营养状况,使用QOL量表评价患者营养支持前后的生存质量。将结果进行统计学分析。结果患者经过营养支持治疗后,其营养状况得到明显改善,与治疗前相比,p<0.05;营养支持后,患者的生存质量得到明显提高,与治疗前相比,p<0.05。结论采用肠内肠外营养支持治疗后,患者的营养状况得到改善,生活质量提高,且不会加速患者的肿瘤生长,其效果显著,值得在临床推广使用。