恶性肠梗阻的营养治疗策略

doi:10.16689/j.cnki.cn11-9349/r.2020.03.024

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摘要恶性肠梗阻是晚期肿瘤患者频发的终末期事件，常伴随重度营养不良和恶液质，严重影响患者治疗疗效和生存质量。合理的肠外肠内营养治疗可以使恶性肠梗阻患者的肠道功能得到一定程度恢复，水、电解质、酸碱平衡紊乱得到纠正，一般状况得到明显好转，从而获得再次姑息性手术或者造瘘的机会，提高生活质量。因此，开展规范化的营养治疗对恶性肠梗阻患者具有重要意义。然而，迄今为止，尚无专门针对恶性肠梗阻患者的营养治疗策略。因此，本文拟通过对恶性肠梗阻患者营养治疗最新国内外文献的全面检索与分析，从恶性肠梗阻患者的营养诊断、营养治疗肠内肠外营养治疗适应证、治疗途径、治疗通路、营养素和疗效评价六个方面分别进行证据论述和意见推荐，以期指导临床营养的治疗。

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	周蕊
	朱翠凤

Abstract：Malignant bowel obstruction (MBO) that incite considerable distress for patients and their families was a common pre-terminal event for patients with advanced cancer. Reasonable nutritional treatment,including parenteral and enteral nutrition, might recover the intestinal function of MBO patients, correct the disturbance of internal environment, and significantly improve the general condition, so as to obtain the opportunity of palliative surgery or fistula, thereby improving the quality of life. Therefore,the standardized nutrition therapy strategy is of great significance to patients with MBO． However, to date,there are no guidelines for nutritional treatment for MBO patients．Therefore, this paper searched and analyzed the latest literature on nutritional treatment of MBO．After repeated discussions and modifications,we developed this nutrition therapy strategy. The guideline discussed the evidence and recommendations from the six aspects of nutrition diagnosis, nutritional treatment indications, treatment access, treatment pathways, nutrients, and efficacy evaluations for patients with malignant bowel obstruction. It has certain guiding significance for the treatment of clinical nutrition.

通讯作者: 朱翠凤，电子邮箱：1794371266@qq.com

引用本文:

周蕊，朱翠凤. 恶性肠梗阻的营养治疗策略[J]. 肿瘤代谢与营养电子杂志, 2020, 7(3): 375-379.
Zhou Rui, Zhu Cuifeng. Strategies for nutritional treatment of malignant bowel obstruction. Electron J Metab Nutr Cancer, 2020, 7(3): 375-379.

1.RIPAMONTI C I, EASSON A M, GERDES H. Management of malignant bowel obstruction［J］. Eur J Cancer, 2008, 44(8):1105-1115.
2.ANTHONY T, BARON T, MERCADANTE S, et al. Report of the clinical protocol committee: development of randomized trials for malignant bowel obstruction［J］. J Pain Symptom Manage, 2007, 34(1 Suppl):S49-S59.
3.COUSINS S E, TEMPEST E, FEUER D J. Surgery for the resolution of symptoms in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer［J］. Cochrane Database Syst Rev, 2016, 2016(1):CD002764.
4.FERGUSON H J, FERGUSON C, SPEAKMAN J, et al. Management of intestinal obstruction in advanced malignancy［J］. Ann Med Surg (Lond), 2015, 4(3):264-270.
5.于世英, 秦叔逵, 谢广茹,等. 晚期癌症患者合并肠梗阻治疗的专家共识［J］. 中华肿瘤杂志, 2007, 29(8):637-640.
6.王东洲,王铁君,李涛.肿瘤患者营养状况对放射敏感性的影响［J］.肿瘤代谢与营养电子杂志, 2016, 3(4):207-210.
7.CLAVIER J B, ANTONI D, ATLANI D, et al. Baseline nutritional status is prognostic factor after definitive radiochemotherapy for esophageal cancer［J］. Dis Esophagus, 2014, 27(6):560-567.
8.MATSUMOTO Y, ZHOU Q, KAMIMURA K, et al. The prognostic nutrition index predicts the development of hematological toxicities in and the prognosis of esophageal cancer patients treated with cisplatin plus 5-fluorouracil chemotherapy［J］. Nutr Cancer, 2018, 70(3):447-452.
9.ARENDS J, BACHMANN P, BARACOS V, et al. ESPEN guidelines on nutrition in cancer patients［J］. Clin Nutr, 2017, 36(1):11-48.
10.王昆华, 石汉平, 赵青川, 等. 营养不良的三级诊断［J］.肿瘤代谢与营养电子杂志, 2015, 2(2):31-36.
11.石汉平, 李薇, 王昆华. PG-SGA 肿瘤患者营养状况评估操作手册［M］. 北京: 人民卫生出版社, 2013:41-43.
12.WEIMANN A, BRAGA M, CARLI F, et al. ESPEN guideline: clinical nutrition in surgery［J］. Clin Nutr, 2017, 36(3):623-650.
13.李健, 邓晓东, 杨元东. 术前营养支持对肠梗阻患者手术预后的影响［J］. 当代医学, 2019,25(12):45-47.
14.GROVES N, TOBIN A.High flow nasal oxygen generates positive airway pressure in adult volunteers［J］.Aust Crit Care, 2007, 20(4):126 -131.
15.FAN B G. Parenteral nutrition prolongs the survival of patients associated with malignant gastrointestinal obstruction［J］. J Parenter Enteral Nutr, 2007, 31(6):508-510.
16.CHERMESH I, MASHIACH T, AMIT A, et al. Home parenteral nutrition (HTPN) for incurable patients with cancer with gastrointestinal obstruction: do the benefits outweigh the risks［J］. Med Oncol, 2011, 28(1):83-88,3.
17.BOZZETTI F. The role of parenteral nutrition in patients with malignant bowel obstruction［J］. Support Care Cancer, 2019, 27(12):4393-4399.
18.FRAT J P,THILLE A W,MERCAT A, et al.High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure［J］.N Engl J Med, 2015, 372(23):2185-2196.
19.刘明, 石汉平. 中国恶性肿瘤营养治疗通路专家共识(2018) ［M］. 北京: 人民卫生出版社, 2018:96-104.
20.QIAN Z Y, SUN Y S, YE Z Y, et al. Application of home enteral nutrition and its impact on the quality of life in patients with advanced gastric cancer［J］. Chin J Gastrointest Surg, 2014, 17(2):158-162.
21.LYU J H, LI T, XIE C H, et al. Enteral nutrition in esophageal cancer patients treated with radiotherapy: a Chinese expert consensus 2018［J］.Future Oncol, 2019, 15(5):517-531.
22.ARENDS J, BODOKY G, BOZZETTI F, et al. ESPEN guidelines on enteral nutrition: non-surgical oncology［J］. Clin Nutr, 2006, 25(2):245-259.
23.饶本强, 石汉平. 恶性肠梗阻:技术、情感和希望的博弈［J］. 肿瘤代谢与营养电子杂志, 2017, 4(2):136-143.
24.江波. 以肠道功能保护与恢复为核心的癌性肠梗阻多学科综合治疗决策［J］. 实用临床医药杂志, 2019, 23:1-4.
25.石汉平,许红霞,李薇.临床能量需求的估算［J］.肿瘤代谢与营养电子杂志, 2015, 2(1):7-10.
26.李涛,吕家华,郎锦义,等.恶性肿瘤放射治疗患者肠内营养专家共识［J］.肿瘤代谢与营养电子杂志, 2017, 4(3):272-279.
27.高纯, 李梦, 韦军民, 等. 复方氨基酸注射液临床应用专家共识［J］.肿瘤代谢与营养电子杂志, 2019, 6(2):183-189.
28.李宁.肠功能障碍的肠内营养策略［J］.肠内与肠外营养, 2010, 17(4):193-194.
29.JENKINS B, HOLSTEN S, BENGMARK S, et al. Probiotics: a practical review of their role in specific clinical scenarios［J］. Nutr Clin Pract, 2005, 20(2):262-270.
30.郭兴华.益生菌基础与应用［M］.北京:北京科学技术出版社, 2002
31.WANG B, WU G Y, ZHOU Z G, et al.Glutamine and intestinal barrier function［J］. Amino Acids, 2015, 47(10):2143-2154.
32.XIA Z, HUANG L, YIN P, et al.L-Arginine alleviates heat stressinduced intestinal epithelial ［J］. Mol Biol Rep, 2019: Epub ahead of print.
33.李涛, 李宝生, 吕家华,等. 食管癌患者营养治疗指南［J］. 肿瘤代谢与营养电子杂志, 2020, 7(1):32-42.