放疗患者的营养状况和营养支.pptx

放疗患者的营养状况和营养支持放疗患者的营养状况放疗患者的营养干预放疗患者营养支持的选择总结随着放疗的进行患者的营养状况不断恶化采用主观全面营养评估量表(SGA)评估84例肿瘤患者放疗期间的营养状况随着放疗的进行，病人的营养状态逐渐下降高凤莉。头颈部肿瘤患者放疗期间营养状态及营养干预效果的研究[D]。北京协和医科大学，2008,35-36.绝大多数放疗患者有不同程度体重丢失前瞻性队列研究，纳入533例接受治愈性放射治疗的头颈部癌症患者放疗期间，30%的患者伴有0.1%-5.0%的体重丢失，26%伴有5.1%-10.0%的体重丢失，24%伴有10.0%的丢失体重丢失0.1%-5.0%体重丢失10.0%体重丢失5.1%-10.0%Langius JA, van Dijk AM, Doornaert P,et al. More than 10% weight loss in head and neck cancer patients during radiotherapy is independently associated with deterioration in quality of life. Nutr Cancer. 2013;65(1):76-83. 体重丢失20%体重丢失20%放化疗（CRT）期间的治疗中断53%黏膜炎+吞咽困难4%头颈部肿瘤患者CRT开始1月后出现黏膜炎和吞咽困难者达87%因严重的黏膜炎，9-19%RT患者中断治疗，29%CRT患者中断治疗肿瘤治疗中断患者Munshi A, Pandey MB, Durga T, et al. Weight loss during radiotherapy for head and neck malignancies: what factors impact it?/pubmed?term=Diehl%20A%5bAuthor%5dcauthor=truecauthor_uidNutr Cancer. 2003;47(2):136-40. Mekhail TM, Adelstein DJ, Rybicki LA, et al. Enteral nutrition during the treatment of head and neck carcinoma: is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube? Cancer,2001;91:1785–1790.Trotti A, Bellm LA, Epstein JB, et al. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol,2003,66:253–262.Capuano G, Grosso A, Gentile PC, et al. Influence of weight loss on outcomes in patients with head and neck cancer undergoing concurrent chemoradiotherapy. Head Neck,2008;30:503–508.放疗期间体重丢失≥5%患者生存率低低体重丢失总生存机率正常体重+高体重丢失低体重 + 高体重丢失NW：正常体重, BMI=18.5-23.0UW: 低体重, BMI18.5OW: 超重, BMI≥23LWL: 低体重丢失 5%HWL: 高体重丢失≥5%时间(月)一项回顾性研究，纳入2433例接受根治性放疗的鼻咽癌患者放疗期间，高体重丢失是鼻咽癌患者生存率低的独立危险因素放疗期间体重丢失5%的患者生存率显著降低，尤其是低体重和正常体重的患者 Shen LJ, Chen C, Li BF, et al. High Weight Loss during Radiation Treatment Changes the Prognosis in Under-/Normal Weight Nasopharyngeal Carcinoma Patients for the Worse: A Retrospective Analysis of 2433 Cases.PLoS One.2013 ,15;8(7):e68660.营养不良是放化疗患者复发的独