摘要
目的探讨个体化肠内营养支持对老年食管癌同期放化疗患者营养状态和疗效的影响分析。方法采用随机数表法将符合入组条件的我院2016年1月初至2019年12月底收治的老年食管癌患者纳入研究对象,共入组126例:研究组(64例),对照组(62例)。所有病患实施的同步放化疗均在我院进行,对照组实施常规营养教育、饮食营养指导及常规营养治疗,研究组实施强化的个体化营养教育和肠内营养支持管理,对比两组的体重丢失情况、体质指数(BMI)、L3骨骼肌质量指数(L3 SMI)、营养相关血液学指标、放化疗不良反应发生率、治疗完成率及近期疗效。结果研究组放化疗后的体重丢失率明显低于对照组(P<0.05),体质指数(BMI)、L3骨骼肌质量指数(L3 SMI)均显著高于对照组(P<0.05)。研究组血红蛋白(Hb)、前白蛋白(PA)、白蛋白(ALB)、淋巴细胞计数(LYM)的降低幅度显著低于对照组(P<0.05)。所有入组患者放射性皮肤损伤均表现为2级及以下,两组差异比较小无统计学意义(P>0.05);3级及以上的放射性咽和食管粘膜损伤在两组患者中均未出现,然而对照组的1级和2级放射性咽和食管粘膜损伤发生率均明显高于研究组(P<0.05);两组1~2级骨髓功能抑制发生率无明显差异(P>0.05),但是对照组≥3级骨髓功能抑制发生率明显高出研究组(P<0.05);对照组放化疗后出现1例放射性肺炎,但两组间差异无明显统计学意义(P>0.05);研究组放化疗完成率为93.75%,明显高于对照组的74.19%,差异有统计学意义(P<0.05),具体表现为未完成放疗总剂量、未行第2周期同步化疗均明显低于对照组(P<0.05)。研究组近期有效率为90.6%,明显高于对照组的74.2%,差异有统计学意义(P<0.05)。结论个体化肠内营养支持对老年食管癌同期放化疗患者的疗效有显著促进作用,能有效改善机体营养状态,提升治疗完成率,降低放化疗并发症的发生率,提高老年食管癌病患的治疗依从性及预后。
Objective To investigate the effects of individualized enteral nutrition support on nutritional status and efficacy in elderly esophageal carcinoma patients treated with concurrent chemoradiotherapy.Methods A total of 126 elderly esophageal carcinoma patients admitted to our hospital from the beginning of January 2016 to the end of December 2019 were enrolled in the study group(64 cases)and the control group(62 cases)by random number table method.Both groups were treated with concurrent chemoradiotherapy in our hospital.The control group received routine nutrition education,dietary guidance and treatment.The study group received intensive individualized nutrition education and enteral nutrition support management.Compared the two groups'weight loss,body mass index(BMI),L3 skeletal muscle mass index,nutrition-related hematological parameters,the toxicities of chemoradiotherapy,the completion rate of treatment,and short-term outcomes.Results Compared with the control group,the study group had significantly lower body weight loss rate after chemoradiotherapy(P<0.05), and the body mass index(BMI)、L3 skeletal muscle mass index(L3 SMI) were significantly higher (P<0.05). The study group had significantly less decreases in hemoglobin(Hb), prealbumin(PA), albumin(ALB) and lymphocyte count(LYM) compared with the control group(P<0.05). The radiation skin injury in the two groups was grade 2 or below, and the difference between the two groups was not statistically significant(P>0.05). There was no grade 3 or above radiation in both groups , but the incidence of grade 1 and 2 radiation pharyngeal and esophageal mucosal injury in the control group was higher than that in the study group(P<0.05). There was no significant difference in grade 1-2 myelosuppression between the two groups(P>0.05), but the incidence of grade ≥3 myelosuppression in the control group was higher(P<0.05). One case of radiation pneumonitis occurred in the control group , but the difference between the two groups was not statistically significant(P>0.05). The chemoradiotherapy completion rate of the study group was 93.75%, significantly higher than 74.19% of the control group, the difference was statistically significant (P<0.05), the specific performance was not completed the total dose of radiotherapy , not the second cycle of concurrent chemotherapy were significantly lower than the control group(P<0.05). The short-term effective rate of the study group was 90.6%, which was significantly higher than 74.2 % of the control group , and the difference was statistically significant(P<0.05).Conclusion: Individualized enteral nutrition support plays a significant role in promoting the efficacy of concurrent chemoradiotherapy for elderly esophageal carcinoma patients. It can effectively improve the nutritional status of the body , improve the completion rate of treatmen,reduce the incidence of complications , and improve the treatment compliance and prognosis of patients .
作者
卢美珍
林志安
郦守国
施升升
王晓燕
黄俊明
Lu Meizhen;Lin Zhian;Li Shouguo;Shi Shengsheng;Wang Xiaoyan;Huang Junming(Department of Radiation Oncology,Zhongshan Hospital Xiamen University,Xiamen361004,China;Department of Neurology,Zhongshan Hospital Xiamen University,Xiamen361004,China;Department of Nutrition,Zhongshan Hospital Xiamen University,Xiamen361004,China;Department of Oncology,Guangzhou Panyu Hospital of Chinese Medicine,Guangzhou511400,China)
出处
《中国现代医生》
2020年第35期66-71,共6页
China Modern Doctor
基金
福建省科学技术厅自然基金课题资助(2019J01561)。
关键词
食管癌
同期放化疗
个体化
肠内营养
营养状态
Esophageal carcinoma
Concurrent chemoradiotherapy
Individualized
Enteral nutrition
Nutritional status
