肿瘤营养治疗的基本原则

1王 林; 2丛明华; 3崔久嵬; 4许红霞; 5陈俊强; 6李 涛; 7李增宁; 8刘 明; 3李 薇; 9郭增清; 10宋春花; 11翁 敏; 12张 琪; 2张 西; 2唐 蒙

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肿瘤代谢与营养电子杂志 ›› 2022, Vol. 9 ›› Issue (6) : 727-734.

共识、指南与标准

肿瘤营养治疗的基本原则

1王林,2丛明华,3崔久嵬,4许红霞,5陈俊强,6李涛,7李增宁,8刘明,3李薇,9郭增清,10宋春花,11翁敏,12张琪,2张西,2唐蒙,3梁婷婷,13陈晓锋,13刘凌翔,14张烽,1贾平平,1于恺英,15唐小丽,16谌永毅,17路潜,18周福祥,19付振明,1杨柳青,1黄慧玲,1王晓琳,1石汉平

作者信息 +

Principles in cancer nutrition therapy

1Wang Lin ，2Cong Minghua ，3Cui Jiuwei ，4Xu Hongxia ，5Chen Junqiang ，6Li Tao ，7Li Zengning ，8Liu Ming ，3Li Wei ，9GuoZengqing ，10Song Chunhua ，11Weng Min ，12Zhang Qi ，2Zhang Xi ，2Tang Meng ，3Liang Tingting ，13Chen Xiaofeng ，13Liu Lingxiang ，14Zhang Feng ，1Jia Pingping ，1Yu Kaiying ，15Tang Xiaoli， 16Chen Yongyi ，17Lu Qian ，18Zhou Fuxiang ，19Fu Zhenming ，1Yang Liuqing ，1Huang Huiling ，1Wang Xiaolin ，1Shi Hanping

Author information +

1Department of Gastrointestinal Surgery / Clinical Nutrition Beijing Shijitan Hospital Capital Medical University Key Laboratory of Cancer FSMP for State Market Regulation Beijing 100038 China 2Department of Comprehensive Oncology National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100021 China 3Cancer Center the First Hospital of Jilin University Changchun 130021 Jilin China 4Department of Clinical Nutrition Daping Hospital Army Medical University Third Military Medical University Chongqing 400042 China 5Department of Gastrointestinal and Gland Surgery the First Affiliated Hospital of Guangxi Medical University Nanning 530021 Guangxi China 6Department of Radiotherapy Sichuan Cancer Hospital & Institute School of Medicine University of Electronic Science and Technology of China Chengdu 610041 Sichuan China 7Department of Nutrition The First Hospital of Hebei Medical University Hebei Province Key Laboratory of Nutrition and Health Shijiazhuang 050031 Hebei China 8Department of General Surgery the Second Affiliated Hospital of Harbin Medical University Harbin 150001 Heilongjiang China 9 The Department of Clinical Nutrition Clinical Oncology School of Fujian Medical University Fujian Cancer Hospital Fuzhou 350014 Fujian China 10Department of Epidemiology College of Public Health Zhengzhou University Zhengzhou 450052 Henan China 11Department of Clinical Nutrition First Affiliated Hospital of Kunming Medical University Kunming 650032 Yunnan China 12Department of Colorectal Surgery Zhejiang Cancer Hospital Hangzhou 310005 Zhejiang China 13Department of Oncology The First Affiliated Hospital of Nanjing Medical University Jiangsu Province Hospital Nanjing 210029 Jiangsu China 14Department of Clinical Nutrition Affiliated Hospital of Jiangnan University Wuxi 214122 JiangSu China 15General Medical Division Ward A Sichuan Cancer Hospital Chengdu 610041 Sichuan China 16Dean's Office Cancer Hospital Affiliated to Xiangya Medical College Changsha 410031 Hunan China 17Division of Medical and Surgical Nursing School of Nursing Peking University Beijing 100191 China 18Department of Radiation and Medical Oncology Zhongnan Hospital Wuhan University Wuhan 430071 Hubei China 19Cancer Center Renmin Hospital of Wuhan University Wuhan 430060 Hubei China

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文章历史 +

摘要

肿瘤营养治疗可以显著改善临床结局、延长生存时间、提高生活质量、节约医疗费用,应该作为肿瘤患者的一线治疗、基础治疗,贯穿于肿瘤治疗的全过程。肿瘤患者应该早期启动全程、主动营养治疗。根据营养诊断结果分类实施营养治疗,遵循膳食优先、口服优先、营养教育优先、肠内营养优先的四个优先原则和营养教育、口服营养补充(ONS)、管饲、部分肠外营养(PPN)及全肠外营养(TPN)五阶梯营养治疗规范。肿瘤营养疗法的基本要求是满足肿瘤患者目标能量及营养素需求,最高目标是调节代谢、控制肿瘤、维护机体功能、提高生活质量、延长生存时间。按照卧床患者 20 ~ 25 kcal / ( kg·d)、活动患者 25~ 30 kcal / (kg·d)计算总能量需求,按照 1. 2~ 1. 5 g / (kg·d)计算蛋白质供给。根据患者胰岛素抵抗情况,调整葡萄糖、脂肪酸供能比例。荷瘤患者建议降低葡萄糖供能比例、增加脂肪酸供能比例。多种药理营养素联合强化配方对肿瘤患者有正面作用。终末期肿瘤患者的营养治疗要求个体化,充分尊重患者及家属的意见。

Abstract

Cancer nutrition therapy can significantly improve clinical outcomes prolong survival time improve quality of life and save medical costs. It should be used as the first - line and basic treatment for cancer patients throughout the whole process of treatment. The cancer patients should start the nutrition therapy entirely and actively at an early stage. According to the nutritional diagnosis nutrition therapy should be implemented correspondingly following the four priority principles of dietary priority oral priority nutritional education priority and enteral nutrition priority and the five - step nutrition therapy specification of nutritional education oral nutritional supplements ONS tube feeding partial parenteral nutrition PPN and total parenteral nutrition TPN . The basic requirement of cancer nutrition therapy is to meet the energy and nutrient requirements of cancer patients and the highest goal is to regulate metabolism control cancer maintain body functions improve quality of life and extend survival time. The total energy requirement is assessed using 20-25 kcal / kg·d for bedridden patients and 25-30 kcal / kg·d for active patients and the protein supply is assessed using 1. 2-1. 5 g / kg·d . The energy supply ratio of glucose and fatty acid should be adjusted in the light of the insulin resistance of patients. It is suggested that tumor-bearing patients should reduce the proportion of glucose and increase fatty acid. The combination of multiple pharmacological nutrients has a positive effect on cancer patients. Nutrition therapy for endstage cancer patients requires individualization and full respect for the opinions of patients and their families.

导出引用

1王林,2丛明华,3崔久嵬,4许红霞,5陈俊强,6李涛,7李增宁,8刘明,3李薇,9郭增清,10宋春花,11翁敏,12张琪,2张西,2唐蒙. 肿瘤营养治疗的基本原则[J]. 肿瘤代谢与营养电子杂志. 2022, 9(6): 727-734

1Wang Lin,2Cong Minghua,3Cui Jiuwei,4Xu Hongxia,5Chen Junqiang,6Li Tao,7Li Zengning,8Liu Ming,3Li Wei,9GuoZengqing,10Song Chunhua,11Weng Min,12Zhang Qi,2Zhang Xi,2Tang Meng. Principles in cancer nutrition therapy[J]. Electronic Journal of Metabolism and Nutrition of Cancer. 2022, 9(6): 727-734