摘要
营养不良在恶性肿瘤放疗患者中发生率高,降低治疗疗效,增加治疗副反应,因此应该对放疗患者常规进行营养风险筛查(推荐采用NRS 2002量表)和营养评估(推荐采用PG-SGA量表)。恶性肿瘤放疗患者在"围放疗期"需要进行全程营养管理。放疗前需根据PG-SGA评分,放疗中需根据PG-SGA评分和RTOG急性放射损伤分级,放疗后需根据PG-SGA评分和RTOG晚期放射损伤分级,规范化、个体化选择营养治疗方式。营养治疗方式遵循"五阶梯模式"。肠内营养途径选择遵循"四阶梯模式"。当患者无法通过肠内营养获得足够的营养需要或出现严重放射性黏膜炎、放射性肠炎或肠功能衰竭时,推荐及时联合部分或全肠外营养。恶性肿瘤放疗患者能量目标量推荐为25～30kcal/(kg·d)。在放疗过程中,患者能量需求受到肿瘤负荷、应激状态和急性放射损伤的影响而变化,因此需要个体化给予并进行动态调整。恶性肿瘤放疗患者推荐提高蛋白质摄入量,对于一般患者推荐1.2～1.5g/(kg·d),对于严重营养不良患者,推荐1.5～2.0g/(kg·d),对于并发恶液质的患者可提高到2.0g/(kg·d)。
The incidence of malnutrition was high in cancer patients receiving radiotherapy.Malnutrition may reduce the antitumor effect and increase the radiotherapy adverse reactions.NRS 2002 is recommended for nutritional risk screening,and PG-SGA is recommended for nutritional assessment.The cancer patients receiving radiotherapy should carry out whole-process nutrition management during the peri-radiation period.We should correctly assess the nutritional status of patients using PG-SGA before,during and after radiotherapy and acute radiation injury during and after radiotherapy according to RTOG criteria.Then,we can select the standardized and individualized nutrition treatment method according to the assessment result.Nutritional therapy should follow the"five-stage model".Enteral nutrition access should follow the"four-stage model".Only when the patient is unable to obtain adequate nutritional needs through enteral nutrition or the presence of severe radioactive mucositis,radiation enteritis or intestinal failure,it is recommended to combine partal or whole enteral nutrition in time.The recommended amount of energy intake for radiotherapy patients with malignant tumor is 25~30kcal/(kg·d).It should be adjusted dynamically according to tumor burden,stress state and acute radiation injury during radiotherapy.Cancer patients receiving radiotherapy are recommend higher protein intake,and 1.5~2.0g/(kg·d)is recommended for patients with severe malnutrition.For patients with cachexia,it can be increased to 2.0g/(kg·d).
作者
李涛
吕家华
郎锦义
石汉平
许红霞
李宝生
章真
祝淑钗
陈明
康静波
石安辉
李建成
赵充
刘士新
杨道科
李光
周福祥
李杭
董丽华
丛明华
申良方
邹丽娟
赵仁
李荣清
无
LI Tao;LV Jia-hua;LANG Jin-yi;SHI Han-ping;XU Hong-xia;LI Bao-sheng;ZHANG Zhen;ZHU Shu-chai;CHEN Ming;KANG Jing-bo;SHI An-hui;LI Jian-cheng;ZHAO Chong;LIU Shi-xin;YANG Dao-ke;LI Guang;ZHOU Fu-xiang;LI Hang;DONG Li-hua;CONG Ming-hua;SHEN Liang-fang;ZOU Li-juan;ZHAO Ren;LI Rong-qing;China Society for Nutritional Oncologyl, Chinese Anti-Cancer Association;Chinese Medical Doctor Association Radiotherapy Doctors Chapter Nutrition Therapy Branch(Sichuan Cancer Hospital Institute/Sichuan Cancer Center/School of Medicine,University of Electronic Science & Technology of China,Chengdu 610041,Sichuan;Fujian Cancer Hospital,Fuzhou350014,Fujian,China;Sun Yat-Sen University Cancer Hospital /Sun Yat-sen University Cancer Center,guangzhou 510060,Guangdong,China;Jilin Cancer Hospital,Changchun 130012,Jilin,China;The First Affiliated Hospital of ZhengzhouUniversity,Zhengzhou 450052,Henan,China;The First Affiliated Hospital of China Medical University,Shenyang 110001,Liaoning,China;Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China;The People's Hospital of GuizhouProvince,Guiyang 550002,Guizhou,China;Department of Jilin University,First Clinical Hospital,Changchun 130021,JilinChina;Cancer Hospital Chinese Academy of Medical Science,Beijing 100021,China;Xiangya Hospital of Centre-southUniversity,Changsha 410008,Hunan,China;Beijing ShijitanHospital,Capital Medical University,Beijing 100038,China;The Second Affiliated Hospital of Dalian Medical University,Dalian 116021,Liaoning,China;General Hospital of Ningxia Medical University,Yinchuan 750004,Ningxia,China;The First Affiliated Hospitalof Kunming Medical University,Kunming 650031,Yunnan,China;Daping Hospital,Research Institute of Surgery Third Military Medical University,Chongqing 400042,China;Shandong Cancer Hospital,Jinan250021,Shandong,China;Fudan University Shanghai Cancer Center,Shanghai 200032,China;The Fourth Hospital of HebeiMedical University,Shijiazhuang 050010,Hebei,China;Zhejiang Cancer Hospital,Hangzhou 310022,Zhejiang,China;NavyGeneral Hospita,Bejing 100048
出处
《肿瘤代谢与营养电子杂志》
2018年第4期358-365,共8页
Electronic Journal of Metabolism and Nutrition of Cancer
基金
吴阶平医学基金(320.6750.16008)
关键词
恶性肿瘤
放射治疗
营养治疗
共识
Malignancies
Radiotherapy
Nutrition therapy
Consensus
