肠内营养支持对恶性实体肿瘤患儿围化疗期血液系统并发症的影响研究  

Effect of enteral nutrition support on hematological complications in children with malignant solid tumor during chemotherapy

作　　者：李凡[1] 张伟令[1] 任卫山 朱霞[1] 胡慧敏[1] 支天[1] 张谊[1] 黄东生[1] Li Fan;Zhang Weiling;Ren Weishan;Zhu Xia;Hu Huimin;Zhi Tian;Zhang Yi;Huang Dongsheng(Department of Pediatrics,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院儿科,北京100730

出　　处：《中华全科医师杂志》2022年第2期154-160,共7页Chinese Journal of General Practitioners

基　　金：中国健康促进基金会儿科营养支持团队(NST)发展科研公益项目(2020)。

摘　　要：目的通过分析恶性实体肿瘤患儿围化疗期的血液常规指标及血液系统并发症的发生情况,探讨肠内营养在改善儿童恶性实体肿瘤化疗相关血液系统并发症中的应用价值。方法以2020年3—12月首都医科大学附属北京同仁医院儿科收治的103例恶性实体肿瘤患儿为研究对象,按照完全随机原则将患儿分为肠内营养组(51例)和对照组(52例)。肠内营养组患儿在常规饮食基础上给予肠内营养支持,对照组患儿仅给予常规饮食,分析各组患儿化疗前后的外周血白细胞、中性粒细胞、血红蛋白及血小板水平,观察化疗后感染发生率以及红细胞、血小板输注情况,并对结果进行比较分析。结果肠内营养组与对照组患儿化疗前的白细胞、中性粒细胞、血红蛋白、血小板水平均显著高于化疗后(肠内营养组:Z=-5.91、-5.59、-5.54、-5.66;对照组:Z=-6.14、-5.84、-5.75、-4.75,均P<0.05);肠内营养组患儿化疗前的血红蛋白水平、化疗后最低血红蛋白水平高于对照组患儿(t=5.68、5.62,均P<0.05),肠内营养组与对照组患儿化疗前后白细胞、中性粒细胞及血小板水平差异均无统计学意义(化疗前:Z=-0.71、-0.12、-1.29;化疗后:Z=-0.39、-0.86、-0.94,均P>0.05);相较于对照组患儿,肠内营养组患儿的化疗前、后贫血程度均改善(χ^(2)=10.45、6.12,均P<0.05),两组患儿白细胞减少、中性粒细胞减少及血小板减少情况比较,差异无统计学意义(化疗前:χ^(2)=1.17、0.10、0.49;化疗后:χ^(2)=0.18、1.10、0.97,均P>0.05);肠内营养组输注红细胞的患儿数低于对照组(χ^(2)=14.06,P<0.05),感染、输注血小板的患儿数与对照组比较差异无统计学意义(χ^(2)=1.20、0.29,均P>0.05);两组患儿中性粒细胞缺乏持续时间差异无统计学意义(t=-1.75,P>0.05)。结论肠内营养支持可以提高患儿围化疗期血红蛋白水平,改善化疗前后贫血的严重程度,减少化疗后输注红细胞的概率,Objective To investigate the effect of enteral nutrition on hematological complications in children with malignant solid tumors during chemotherapy.Methods A total of 103 children with malignant solid tumor admitted to our hospital from March 2020 to December 2020 were enrolled in the study.The children were randomly divided into enteral nutrition group(n=51)and control group(n=52).Children in enteral nutrition group were given enteral nutrition support on the basis of routine diet,while children in control group were only given routine diet.The levels of leukocytes,neutrophils,hemoglobin and platelets in peripheral blood of children during chemotherapy were analyzed.The incidence of infection and the transfusion of red blood cells and platelets after chemotherapy were documented and compared between two groups.Results The levels of white blood cells,neutrophils,hemoglobin and platelets before chemotherapy were significantly higher than those after chemotherapy both in enteral nutrition group(Z=-5.91,-5.59,-5.54,-5.66,all P<0.05)and in control group(Z=-6.14,-5.84,-5.75,-4.75,all P<0.05).The overall hemoglobin levels in enteral nutrition group before and after chemotherapy was significantly higher than those in control group(t=5.68,5.62,P<0.05),and there were no significant differences in the levels of white blood cells,neutrophils and platelets between the two groups before chemotherapy(Z=-0.71,-0.12,-1.29,all P>0.05)and after chemotherapy(Z=-0.39,-0.86,-0.94,all P>0.05).Compared with the control group,the degree of anemia during chemotherapy was significantly improved in enteral nutrition group(χ^(2)=10.45,6.12,all P<0.05),but there was no significant difference in the reduction degree of white blood cells,neutrophils and platelets between the two groups(before chemotherapy:χ^(2)=1.17,0.10,0.49;after chemotherapy:χ^(2)=0.18,1.10,0.97,all P>0.05).The number of children receiving red blood cell transfusion in enteral nutrition group was significantly lower than that in control group(χ^(2)=14.06,P<0.05),and the

关 键 词：营养支持 儿童 肿瘤 贫血 化学疗法 

分 类 号：R730.53[医药卫生—肿瘤]