家庭肠内营养对改善晚期胃癌患者生活质量的应用价值

目的研究家庭肠内营养（HEN）对晚期胃癌患者改善生活质量的意义。方法回顾性分析浙江省人民医院胃肠外科2010年6月1日至2012年6月1日连续收治的60例无法手术切除及复发转移的晚期胃癌患者的病历资料，根据是否进行HEN分为肠内营养（EN）组（25例）和对照组（35例）。EN组营养支持方式包括经空肠造瘘管EN、经鼻胃肠管完全或部分EN；对照组中存在胃癌伴梗阻的患者进行全肠外营养（TPN），其余患者完全经口饮食。在持续1年的随访过程中，分别于第1、3、6和12月进行Kamofsky评分和Spitzer指数测定。第6月时行EORTCQLQ—c30评分。全组患者均接受FLOFOX4方案（奥沙利铂、四氢叶酸钙、氟尿嘧啶）静脉化疗。结果两组患者在基线资料方面差异无统计学意义。1年随访期间，两组共有53例患者死亡，其中EN组21例，对照组32例。KamoHky评分结果显示，EN组在第3、6、12月的评分结果分别为平均57．4、39．6和28．2，明显优于对照组的平均45．3、29．2和20．1（分别为P=0．041、P=0．012和P=0．015）。Spitzer评分结果显示，EN组在第3、6、12月的评分结果分别为5．12、4．04和2．54，也明显优于对照组的4．32、3．21和1．97（分别为P=0．048、P=0．035和P=0．024）。EROTCQLQ-30评分结果显示，EN组在功能量表方面同样均明显优于对照组（均P〈0．05），“呼吸费力”、“疼痛”和“疲劳”阳性症状较对照组轻（分别为P=0．025、P=0．044和P=0．016）；但“腹泻”症状较对照组明显（P=0．047）。结论HEN作为一项营养干预措施，能在有限的生存期内改善晚期胃癌患者的生活质量。

Application of home enteral nutrition and its impact on the quality of life in patients with advanced gastric cancer

Objective To investigate the application of home enteral nutrition（HEN） in patients with advanced gastric cancer and its impact on the quality of life. Methods Data of 60 consecutive patients with advanced gastric cancer, who could not underwent operation and had relapse metastasis, from June 2010 to June 2012 were retrospectively analyzed. According to familial nutritional pattern, these 60 patients were divided into HEN group（25 eases） receiving home enteral nutritional support and control group （35 cases）. HEN patients were supported through jejunostomy tube or nasa/gastric tube. Control patients were supported through total parental nutrition or purely eating respectively. All the patients received intravenous chemotherapy and evaluated by Karnofsky index and Spitzer system in the first, third, sixth and twelfth month. In the sixth month, patients were also examined by EORTC QLQ- c30. Results No significant differences were found between the two groups according to 8 elements containing age, sex, BMI, etc. A total of 53 patients died within one year, including 21 in HEN group and 32 in control group. The Karnofsky scales showed that HEN group scored meanly 57.4, 39.6 and 28.2 in the third, sixth and twelfth month respectively, which were significantly higher than those of control group （45.3, 29.2 and 20.1, P=0.041, P=0.012 and P=0.015 respectively）. The Spitzer scales showed that HEN group scored meanly 5.12, 4.04 and 2.54 on average in the third, sixth and twelfth month respectively, which were significantly higher than those of control group （4.32, 3.01 and 1.97, P=0.048, 0.035 and P=0.024 respectively）. The EROTC QLQ-C30 scales showed that HEN group scored higher than control group in functional scales （P〈0.05）, and lower in the symptom scales of short breathing, pain and tired （P=0.025, P=0.044, P=0.036 respectively）, while higher in diarrhea（P=0.047）. Conclusions The quality of life of patients with advanced gastric cancer declines gradually with the nutritional status deteriorating. HEN can be applied to improve the nutritional status and quality of life.