伴吞咽困难的Ⅳa/b期食管癌患者放疗或同步放化疗期间不同营养治疗模式应用研究-现代医学

伴吞咽困难的Ⅳa/b期食管癌患者放疗或同步放化疗期间不同营养治疗模式应用研究

单位：1. 江苏省人民医院放疗科, 江苏南京 210029;
2. 江苏省人民医院营养科, 江苏南京 210029

分类号：R735.1

出版年·卷·期（页码）：2022·50·第十一期（1382-1387）

摘要：

目的：探讨不同营养治疗模式对伴有吞咽困难的Ⅳa/b期食管癌患者放疗或同步放化疗期间营养状态及放射性损伤的影响。方法：选取2016年1月至2019年12月我院放疗科收治的52例伴吞咽困难的Ⅳa/b期食管癌患者，随机分为对照组和试验组各26例。对照组给予常规膳食营养指导及必要时肠外营养治疗，试验组根据患者梗阻情况，在常规膳食营养指导基础上，口服或管饲营养素，并辅以肠外营养治疗，直至治疗结束。比较两组治疗前后主观综合性营养评估分级，白蛋白(ALB)、前白蛋白(PA)、总蛋白(TPF)、视黄醇结合蛋白(RBP)、血红蛋白浓度(Hb)等血清学营养指标，近期疗效和RTOG分级急性毒性反应情况。结果：治疗前，两组主观综合性营养评估分级及血清学营养指标比较，差异均无统计学意义(P＞0.05)；治疗后，试验组营养良好的患者比例显著高于对照组，轻、中、重度营养不良的发生率均显著低于对照组(均P＜0.05)；试验组治疗前后血清学营养指标比较，差异均无统计学意义(均P＞0.05)，对照组治疗后各血清学营养指标均显著低于治疗前(均P＜0.05)。试验组近期疗效评价总有效率显著高于对照组，试验组放射性食管炎和骨髓抑制发生率显著低于对照组(均P＜0.05)。结论：伴有吞咽困难的Ⅳa/b期食管癌患者放疗或同步放化疗早期及治疗全过程中，有计划的、专业的精准营养干预可明显改善患者整体营养状况和近期疗效，降低放射性损伤的发生。

Objective: To investigate the effects of different nutritional treatment modes on the nutritional status and radiation injury of patients with dysphagia with stage Ⅳ a/b esophageal cancer during radiotherapy or concurrent radiotherapy and chemotherapy. Methods: 52 patients of stage Ⅳ a/b esophageal cancer with dysphagia admitted to the radiotherapy department of our hospital from January 2016 to December 2019 were randomly divided into control group and test group with 26 patients，respectively. Control group were given routine dietary nutrition guidance and parenteral nutrition treatment when necessary. Test group took orally or orally administered nutrients based on the patients' obstruction and conventional dietary nutrition guidance, and supplemented with parenteral nutrition treatment until the end of the treatment. Subjective Global Assessment(SGA), serum nutritional indicators(albumin, prealbumin, total protein, retinol binding protein and hemoglobin concentration), short-term efficacy and RTOG grade acute toxicity were compared between the two groups before and after treatment. Results: Before treatment, there was no significant difference between the two groups in SGA scores and serum nutritional indicators(P>0.05); After treatment, the proportion of patients with good nutrition in test group was significantly higher than that in control group, and the incidences of mild, moderate and severe malnutrition were significantly lower than those of control group(P<0.05); There was no statistically significant difference in the serum nutritional indicators before and after treatment in test group(P>0.05), while those in control group were significantly lower after treatment than before(P<0.05). The total effective rate of short-term efficacy evaluation in test group was significantly higher than that of control group,and the incidence of radiation esophagitis and myelosuppression in test group were significantly lower than those of control group(P<0.05). Conclusion: In the early stage and the whole process of radiotherapy or radiotherapy and chemotherapy for patients with stage Ⅳ a/b esophageal cancer with dysphagia, the planned and professional precise nutrition intervention can significantly improve the overall nutritional status of patients, improve the short-term efficacy of patients, and reduce the occurrence of radiation damage.

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