口服营养补充对头颈部肿瘤同步放化疗期间营养状况及毒副反应的影响  

Effects of Oral Nutritional Supplements on Nutritional Status and Toxicity of Hospitalized Patients with Head and Neck Tumors during Chemoradiotherapy

作　　者：张丽莉[1] 何淼[2] 何迎盈[2] 王涛 谢雪健 Zhang Lili;He Miao;He Yingying;Wang Tao;Xie Xuejian(Department of Clinical Nutrition,Deyang People's Hospital,Deyang 618000,Sichuan,China;Department of Oncology,Deyang People's Hospital,Deyang 618000,Sichuan,China)

机构地区：[1]德阳市人民医院临床营养科,四川德阳618000 [2]德阳市人民医院肿瘤科,四川德阳618000

出　　处：《肿瘤预防与治疗》2020年第10期858-864,共7页Journal of Cancer Control And Treatment

摘　　要：目的:探讨口服营养补充对头颈部恶性肿瘤同步放化疗期间营养状况及毒副反应的影响。方法:2018年3月至2019年6月在德阳市人民医院住院的头颈部恶性肿瘤行同步放化疗的患者70例,按随机数字表法分为干预组和对照组,每组35例。两组患者入院后均行患者主观整体评估(Patient-Generated Subjective Global Assessment,PGSGA)营养评估。对照组给予营养咨询,常规膳食指导;干预组在对照组的基础上,在同步放化疗开始时至同步放化疗结束(同步化疗2周期),给予口服整蛋白型肠内营养制剂400 m L/d(能量400 kcal,蛋白质15 g)进行营养补充,共计(46.23±3.13)d。检测两组患者同步放化疗前和同步放化疗结束后血液总蛋白、白蛋白、前白蛋白、血红蛋白水平,统计营养不良发生率,和两组患者同步放化疗中断时间和不良反应等资料。结果:干预组同步放化疗结束后营养不良发生率低于对照组,差异有统计学意义(P<0.05)。两组在同步放化疗前,总蛋白、白蛋白、前白蛋白、血红蛋白均值的比较差异无统计学意义(P值均>0.05)。同步放化疗结束后,干预组的总蛋白、白蛋白、前白蛋白、血红蛋白均较对照组高,两组差异均有统计学意义(P值均<0.05)。同步放化疗结束后干预组总蛋白、白蛋白、前白蛋白、血红蛋白较同步放化疗前虽有降低,但差异无统计学意义(P值均>0.05);而对照组同步放化疗后总蛋白、白蛋白、前白蛋白、血红蛋白较前降低,差异有统计学意义(P值均<0.05)。同步放化疗期间白细胞减少症的发生率按照其减少的严重程度干预组Ⅰ级28.57%、Ⅱ级68.57%、Ⅲ级2.86%、Ⅳ级0%,和对照组白细胞减少症的发生率Ⅰ级34.29%、Ⅱ级45.71%、Ⅲ级14.29%、Ⅳ5.71%的比较,两组差异无统计学意义(P>0.05)。口腔黏膜炎发生率比较,两组差异无统计学意义(P>0.05)。平均中断治疗天数干预组为(1.09±1.06)d,对照组为(1.80±1Objective:To investigate the effect of oral nutritional supplements on the nutritional status and toxicity of hospitalized patients with head and neck tumors during chemoradiotherapy.Methods:From March 2018 to June2019,70 hospitalized patients with head and neck malignant tumors were treated with chemoradiotherapy in Deyang People’s Hospital.They were assigned to the intervention group(treated with oral nutritional supplements)and the control group using a random number table,with 35 cases in each group.The nutritional status of patients was evaluated with Patient-Generated Subjective Global Assessment(PG-SGA).The two groups were given nutritional counseling and routine dietary guidance,and oral nutritional supplements(energy 400 kcal,protein 15 g)during chemoradiotherapy(2 weeks)were added to the intervention group for(46.23±3.13)d.Pre-and post-chemoradiotherapy total protein(Tp),albumin(Alb),prealbumin(p Alb)and hemoglobin(Hb)levels,time-totreatment discontinuation(TTD)and adverse reactions in two groups were tested.Results:After chemoradiotherapy,the incidence of malnutrition in the intervention group was lower than that in the control group,and the difference was statistically significant(P<0.05).There were no significant differences in the mean values of Tp(P=0.085),Alb(P=0.280),p Alb(P=0.910)and Hb(P=0.179)between the two groups before chemoradiotherapy(P>0.05).After chemoradiotherapy,Tp(P=0.009),Alb(P=0.004),p Alb(P=0.007)and Hb(P=0.001)in the intervention group were higher than those in the control group,and the difference between the two groups was statistically significant(P<0.05).The aforementioned 4 nutritional indicators in the intervention group dropped after chemoradiotherapy,but the difference was not significant(P>0.05),while those in the control group dropped significantly(P<0.05).The incidences of grade I,II,III and IV leukopenia were 28.57%,68.57%,2.86%and 0%in the intervention group,and were 34.29%,45.71%,14.29%and 5.71%in the control group.The difference between the two groups was statist

关 键 词：口服营养补充 头颈部肿瘤 放化疗 营养状况 

分 类 号：R396[医药卫生—基础医学] R398