目的评估消化道恶性肿瘤患者的能量消耗，探讨最佳计算公式及能量消耗的影响因素。方法采用连续入组法，纳入2016年3月至2016年12月在陆军军医大学第一附属医院肿瘤科住院治疗患者，运用代谢车测定其静息代谢能量（REE），使用Harris-Benedict公式和30kcal/（kg·d） 公式预测患者的一日总能量消耗（TEE）。收集研究对象的相关指标如年龄、身高、体重、病程、原位癌部位、是否荷瘤等。结果共纳入26例患者，其中包括食管癌11例，胃癌8例，结直肠癌7例，73%的患者处于高代谢状态，约69%的患者处于肿瘤Ⅳ期；其中不同病程和原位癌位置与静息能量消耗有差异，差异具有统计学意义；用30kcal/（kg·d）×体重估算TEE可能并不适用于消瘦的消化道肿瘤患者。结论消化道恶性肿瘤患者大多存在营养不良且处于高代谢状态，在给消化道恶性肿瘤患者提供能量时应适当考虑病程长短、肿瘤分期以及肿瘤部位等因素。尽量使用代谢车估算恶性肿瘤患者的TEE，若没有代谢车条件时，对于能下床活动的消化道恶性肿瘤患者，体质指数（BMI）≥18.5kg/m2者推荐使用30kcal/（kg·d）×实际体重的方法估算TEE，BMI<18.5kg/m2者推荐使用30kcal/（kg·d）×标准体重的方法估算TEE。
Abstract
Objective To evaluate the energy consumption of patients with digestive tract cancer, and to explore the optimal calculation formula and the influencing factors of energy consumption. Methods The patients in the oncology department of our hospital from March 2016 to December 2016 were consecutively enrolled in this study. The resting energy expenditure(REE) was measured by the metabolic cart. The 30kcal/(kg·d) coefficient and Harris-Benedict equation were used to predict the total daily energy expenditure (TEE) of patients. The related indices such as age, height, weight, course of disease, location of primary tumor and so on were collected. Results There was a total of 26 patients, including esophageal cancer(n=11), gastric cancer(n=8), and colorectal cancer(n= 7). 73% of the patients were in a state of high metabolism, about 69% of patients are in tumor stage Ⅳ. The course of disease, treatment times and tumor stage were positively correlated with REE and were statistically significant. The estimation of TEE by 30kcal/(kg·d) formula multiplied by body weight may not be suitable for the patients who was wasted. Conclusion Most of the digestive tract cancer patients were malnourished and in a state of high metabolism. When providing energy to the patients, we should properly consider whether or not to bear the tumor, the course of the disease, the frequency of treatment, tumor stage and tumor location. Using metabolic carts to estimate the TEE of digestive tract cancer patients is recommended. If a metabolic cart is not available, and the patients are not bedridden, if the BMI was≥18.5kg/m2, the TEE can be estimated by the equation that 30kcal/(kg·d) multiplied the actual body weight, when the BMI was<18.5kg/m2, the equation that 30kcal/(kg·d) multiplied the standard body weight is recommended.
关键词
消化道恶性肿瘤 /
静息能量消耗 /
能量评估 /
肿瘤
Key words
Digestive tract cancer /
Resting energy expenditure /
Energy evaluation /
Oncology
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