关键词: 上消化道恶性肿瘤, 肠外营养干预, 放化疗, 疗效, 生活质量

Abstract:

Objective To investigate the effect of parenteral nutrition intervention on the curative effect and quality of life of patients with upper gastrointestinal malignant tumor undergoing radiotherapy. Methods  Eighty patients with upper gastrointestinal malignancies who received radiotherapy and chemotherapy in our houspital from Nov. 2014 to Jun. 2017 were randomly divided into control group （n=40） and observation group （n=40）. All patients were given conventional intensity modulated radiation therapy （IMRT） and TP regimen. Patients in the observation group were given intravenous drip of 20.0％ fat emulsion， compound amino acid and 10.0％ glucose from Monday to Friday. The daily nutritional energy was 30-40 kcal／kg until the end of radiotherapy and chemotherapy. The patients in the control group ate their own foods， and were treated with symptomatic treatment when severe mucosal reactions or electrolyte disturbances occurred. The short-term efficacy and adverse reactions of the two groups were compared， and the nutritional indicators and quality of life before and after treatment were compared. Results The total effective rates of the observation group and the control group were 90％ and 72.5％ respectively， and the difference was statistically significant （P=0.042）. After treatment， the levels of HB， ALB and TLC in the observation group were （109.52±6.13） g／L， （31.06±3.29） g／L and TLC （2.90±0.56）×109／L higher than those in the control group（98.40±6.65） g／L， （24.91±3.63） g／L， （1.81±0.52）×109／L， respectively， and the difference was statistically significant （P＜0.05）. The scores of general health， physical function， social function， emotional function， cognitive function and role function in the observation group were 66.03±7.58， 64.96±6.81， 66.18±6.23， 69.74±6.95， 63.24±6.07 and 65.58±6.26 respectively， which were higher than those in the control group 52.92±8.47， 54.10±5.39， 51.38±5.70， 57.25±6.13， 54.76±5.98 and 50.90±5.62，the difference was statistically significant （P＜0.05）. After 4 weeks of treatment and at the end of treatment， the body mass and KPS scores of the observation group were（66.72±5.83）kg， （65.87±5.75） kg and 66.14±8.49，64.93±7.74 respectively， which were significantly higher than those of the control group （P＜0.05）. The number of 3-4 grade adverse reactions such as gastrointestinal symptoms， oral mucosal injury， skin reaction， anemia and thrombocytopenia in the observation group was significantly less than that in the control group. Conclusion Parenteral nutrition can improve the curative effect of radiotherapy and chemotherapy for upper gastrointestinal malignancies， improve the nutritional status of the body， reduce the occurrence of adverse reactions of radiotherapy and chemotherapy， and improve the quality of life of patients， which is worthy of clinical promotion.

Key words: Upper digestive tract malignant tumor, Parenteral nutrition intervention, Chemoradiotherapy, Curative effect, Quality of life（QoL）