目的 探讨能量摄入量对头颈癌患者放化疗期间营养状况、体成分及生活质量的影响。方法 选取符合入选标准 的头颈癌患者 90 例，分别在放化疗前和放疗结束 2 个时段对患者进行调查，调查内容包括：营养评估、膳食调查、体成分 测量以及生活质量四个部分。临床营养师通过 24 小时膳食调查获得患者的能量摄入量，包括膳食能量摄入以及 ONS，同 时采用 Harris-Benedict 公式获得患者的能量需要量，从而计算患者的能量摄入量占需要量的比例，能量摄入占比＜ 70% 为 A 组，能量摄入占比≥ 70% 为 B 组。结果 两组患者的基线资料，包括年龄、性别、BMI、治疗前的营养状况、临床分期、 诊断、放疗剂量以及治疗方式等方面差异均无统计学意义（P ＞ 0.05），两组具有可比性。放疗结束后，A 组患者营养不 良发生率明显高于 B 组，A 组患者营养不良发生率为 100%，B 组为 84.09%，差异具有统计学意义（P ＜ 0.05）；24 小时 膳食调查发现，A 组患者每天通过膳食和 ONS 摄入的能量分别为 864kcal 和 214kcal，明显低于 B 组，差异具有统计学意义（P ＜ 0.05）。使用放疗前后体成分的变化值来表示能量摄入量对体成分的影响，发现 A 组患者 BMI、体重、肌肉、蛋白质、 骨骼肌和体脂百分比的变化均大于 B 组，两组除了蛋白质和骨骼肌的变化没有统计学意义外，其他指标差异均具有统计 学意义（P ＜ 0.05）；放疗前，两组患者生活质量评分没有明显的统计学差异；放疗结束后，A 组患者功能评分均比 B 组 偏低，而症状评分都偏高；在生活质量、认知功能、疼痛、疲倦、食欲丧失等方面两组间差异都具有统计学意义。结论 头 颈癌患者经放化疗后，营养状况、体成分及生活质量恶化，而在治疗前和治疗过程中保持能量摄入量占比≥ 70% 可以防止 进一步恶化。

Objective To evaluate the effect of different levels of energy intake on nutritional status and quality of life in patients with head and neck cancer during radiochemotherapy. Methods Four items including nutritional assessment, dietary survey, measuring body composition and quality of life were employed to investigate 90 patients with head and neck cancer which meet the inclusion criteria in two periods, including the stage before radiochemotherapy and the end of radiotherapy. Dietary intake was estimated by a 24h dietary recall conducted by the oncology dietitian each time, including energy from food and oral nutritional supplements. Energy requirements were estimated by using Harris-Benedict equation, then the energy ratio was calculated. The proportion of energy intake<70% was group A, and the proportion of energy intake≥70% was group B. Results There were no significant differences in clinical data, including age, gender, BMI, nutritional status, clinical stage, dignosis, radiological dose and treatment method between group A and group B (P>0.05), so the two groups were comparable. At the end of radiotherapy, the incidence of malnutrition in group A was significantly higher than group B, the incidence of malnutrition in group A and group B were 100% and 84.09%, respectively. According to 24h dietary recall, the energy intake from food and ONS in group A were 864kcal and 214kcal, respectively, which were significantly lower than group B (P<0.05). The influences on body compositions by energy intake were expressed by the changes before and after radiotherapy. The results showed that the changes of BMI, weight, muscle mass, protein, skeletal mass and percentage of body fat in group A were greater than in group B. All the changes beween two group had significant differences (P <0.05), besides the changes of protein and skeletal mass. Before radiotherapy, there were no significant differences in life quality scores between two groups. However, at the end of the radiotherapy, the functional scores were lower in group A than in group B, the symptom scores are higher in group A than in group B. There were significant differences in the total quality of life, cognitive function, pain, fatigue, loss of appetite between two groups. Conclusions The nutritional status, body composition and life quality deteriorate for patients with head and neck cancer after radiochemotherapy. Nevertheless, maintaining the energy intake≥70% could prevent further deterioration.