目的探讨以指南为依据的肿瘤放疗患者营养教育咨询方案，在降低质子重离子治疗期间显著体重下降发生率方面 的有效性。方法以质子重离子治疗期间的肿瘤放疗患者为研究对象，采用历史对照研究设计，方案实施前以2016年1月至12月 收治的患者为对照组，方案实施后以2018年1月至8月收治的患者为试验组。对照组在方案实施前仍实行原有的常规护理，试验 组给予以指南为依据的营养教育咨询方案。结果本研究共纳入713例肿瘤患者，其中对照组374例，试验组339例，两组平均年 龄为54岁和53岁，45%和49%为头颈部肿瘤患者。放疗期间对照组平均体重下降0.51 kg，平均体重丢失0.75%，显著体重下降 发生率为11.2%（42例）；试验组体重下降0.66 kg，平均体重丢失0.90%，显著体重下降发生率为9.4%（32例）。在控制放疗总剂量、 射线类型、肿瘤部位、同期化疗和性别的混杂因素影响后，试验组显著体重下降的风险下降了34%（OR=0.66，95%CI=0.48~0.91）。 结论以指南为依据的肿瘤放疗患者营养教咨询方案能够帮助改善质子重离子治疗期间的患者营养状态，有效降低显著体重下 降的风险。

Objective Critical weight loss not only reduces quality of life, but also affects prognosis. This study validated its effectiveness in reducing the incidence of critical weight loss during proton and heavy ion therapy by implementing a guideline⁃based nutrition education and counselling program. Methods Patients during proton heavy ion therapy were recruited, and a historical control study design was adopted. The patients treated from Jan to Dec 2016 were used as the control group, and the patients from Jan to Aug 2018 as experimental group. The control group still received the original routine care, and the experimental group was given a nutrition education and counselling program based on the guidelines. Results A total of 713 cancer patients were included in the study, including 374 patients in the control group and 339 patients in the experimental group. The average age of the two groups was 54 and 53 years, and 45% and 49% were patients with head and neck cancer. The average weight loss during radiotherapy was 0.51 kg (0.75%) in the control group, and the rate of critical weight loss was 11.2% (42 cases); the experimental group lost 0.66 kg (0.90%), and the rate of critical weight loss was 9.4% (32 cases). After controlling the confounding factors of total radiation dose, radiation type, tumor location, concurrent chemotherapy, and gender, the risk of significant weight loss in the experimental group decreased by 34% (OR=0.66, 95%CI=0.48-0.91). Conclusion Guideline⁃based nutrition education and counselling programs can help improve the nutritional status of patients during proton and heavy ion therapy and effectively reduce the risk of significant weight loss