基于循证医学的恶性肿瘤患者营养全程管理

Evidence-based whole range nutritional therapy for cancer patients

摘要:

恶性肿瘤患者常面临较高的营养风险，且营养不良发生率显著增高，二者不仅严重影响抗肿瘤治疗效果，还会显著降低患者的生活质量，并对临床结局产生不利影响。本文基于ASPEN、ESPEN、CSPEN及CSCO等国内外学术组织发布的最新营养支持指南，系统阐述了肿瘤患者营养全程管理的“筛-评-诊-治”闭环路径。内容涵盖营养风险筛查的时机与工具、能量与营养素供给原则、围手术期与放化疗期间营养支持策略、营养支持的“五阶梯”模式以及居家营养支持等。对于肿瘤患者，应强调早期营养风险筛查、个体化评估及合理干预的重要性，同时营养支持应贯穿肿瘤治疗全程，以改善营养状况、增强治疗耐受性、降低并发症、提升生存质量。

Abstract:

Patients with cancer often suffer from high nutritional risk and prevalence of malnutrition; and the latter two are obviously associated with bad effects of anti-tumor treatment, worsen life quality, and increased risk of mortality. Based on the newest nutritional support guidelines released by American Society for Parenteral and Enteral Nutrition(ASPEN), European Society for Clinical Nutrition and Metabolism(ESPEN), Chinese Society for Parenteral and Enteral Nutrition(CSPEN), and Chinese Society of Clinical Oncology(CSCO), this article try to elaborate systematically on the “screening-assessment-diagnosis-treatment” closed-loop path for the whole-range nutritional therapy for cancer patients. The paper covers the timing and tools for nutritional risk screening, principles of energy and nutrient supplementation, nutritional therapy during perioperative period and radiotherapy and chemotherapy, the “five-level” model of nutritional support, and home nutritional support, etc. For cancer patients, early screening, individualized assessment, and optimal nutrition therapy should be highlighted. Furthermore, nutritional therapy should also be integrated with other anti-cancer intervention during the whole range of cancer treatment, thus to improve nutritional status, increase treatment tolerance, reduce risk of complications, and improve life quality and survival.