肠内联合肠外营养支持用于老年晚期消化道恶性肿瘤化疗患者的观察
Combined parenteral and enteral nutrition support with chemotherapy in treating elderly patients with advanced gastrointestinal cancer
目的 探讨肠内联合肠外营养支持对老年晚期消化道恶性肿瘤化疗的影响.方法 将2006年至2011年本院肿瘤内科收治的79例老年晚期消化道恶性肿瘤患者采用随机数字表法分为两组,治疗组(n=42)采用营养支持联合化疗,对照组(n=37)采用单纯化疗,入院后行营养风险筛查,2个化疗周期后比较营养状态、Karnofsky功能状态评分、毒性反应、院内感染率的变化.结果 两个周期化疗后,治疗组的体重指数[(19.00 ±3.31) kg/m2比(18.24± 1.98) kg/m2,P=0.04]、白蛋白[(33.90±1.50) g/L比(29.90 ±2.38) g/L,P=0.02]、前白蛋白[(28.19±1.50) g/L比(25.51±8.38)g/L,P=0.01]、血红蛋白[(107.0±6.90) g/L比(104.20±9.70) g/L,P=0.02]、淋巴细胞[(2.99±0.55) ×109/L比(2.63±0.20) ×109/L,P=0.03]均显著升高.化疗不良反应方面,治疗组骨髓抑制发生率明显低于对照组(28.57%比83.78%,P=0.00);治疗组中有营养风险者的骨髓抑制发生率为31.03%,显著低于对照组的95.45% (P=0.00),其他毒性反应差异无统计学意义.治疗组两次化疗后的院内感染发生率均显著低于对照组(0比10.81%,P=0.03;2.38%比27.03%,P=0.02).结论 老年晚期消化道恶性肿瘤患者化疗期间联合应用肠内加肠外营养支持有利于机体营养状况及体能的改善,减轻毒性反应,是院内感染发生的保护性因素.营养支持符合化疗患者的需求,具有安全、有效、合理的特点.
更多Objective To study the value of combined parenteral and enteral nutrition support with chemotherapy for advanced gastrointestinal cancer in elder patients.Methods Totally 79 patients admitted from 2006 to 2011 were randomly divided into two groups using random number table:the treatment group (n=42) was provided with combined parenteral and enteral nutrition support and chemotherapy,the control group(n =37) was treated with chemotherapy only.Nutritional risks were screened at admission.After two cycles of chemotherapy,the nutritional status,Karnofsky performance score,toxic reaction,and nosocomial infection rate were compared betweeen these two groups.Results After 2 cycles of chemotherapy,the body mass index[(19.00±3.31) kg/m2 vs.(18.24±1.98) kg/m2,P=0.04],albumin [(33.90±1.50) g/Lvs.(29.90±2.38) g/L,P=0.02],prealbumin [(28.19±1.50) g/Lvs.(25.51 ±8.38) g/L,P=0.01],hemoglobin [(107.0 ± 6.90) g/L vs.(104.20 ± 9.70) g/L,P =0.02],and lymphocyte levels [(2.99 ±0.55) × 109/L vs.(2.63 ±0.20) × 109/L,P =0.03] were all significantly higher in the treatment group.The incidence of myelosuppression in the treatment group was 28.57%,significantly lower than that in the control group (83.78%,P =0.00) ; such difference was also detected in patients with nutritional risk in the 2groups (31.03% vs.95.45%,P =0.00).The incidences of nosocomial infection in the treatment group were significantly lower than in the control group after both the first and the second cycle of chemotherapy (0 vs.10.81%,P=0.03; 2.38% vs.27.03%,P=0.02).Conclusions Combined enteral and parenteral nutrition support with chemotherapy in elderly patients with advanced gastrointestinal caner could improve nutritional status,reduce toxic reaction,and prevent nosocomial infection.Therefore combined nutrition support is a safe and effective approach for elderly patients with advanced gastrointestinal cancer.
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