肺癌术后化疗患者不同营养治疗方式对临床效果的影响*

Effects of different nutritional treatments on lung cancer patients undergoing postoperative chemotherapy*

摘要:

目的 观察不同营养治疗方式对肺癌术后化疗患者临床效果的影响。方法 采用前瞻性研究，选取2015年7月—2017年12月成都医学院第一附属医院胸外科行肺癌手术且行术后化疗的初筛入组患者754例作为研究对象。观察住院期间肠内营养（EN）、EN+肠外营养（PN） 2种营养治疗方式对肺癌患者术后化疗期间营养状况、免疫功能、并发症的影响。Logistic回归分析2种营养治疗方式及其他因素与营养治疗并发症和肺癌术后并发症的关系。结果 6周最终完成随访患者427例。其中单纯EN治疗（EN组）患者301例（70.5%），EN+PN治疗（EN+PN组）患者126例（29.5%）。两组的血清总蛋白（TP）、白蛋白（ALB）、前白蛋白（PA）、免疫球蛋白（IgG、IgA）水平比较，差异无统计学意义（P?>0.05）；免疫球蛋白（IgM）及淋巴细胞计数（TLC）比较，差异有统计学意义（P?<0.05）。两组共发生营养治疗并发症69例，其中EN组58例，EN+PN组11例，差异有统计学意义（P?<0.05）；共发生肺癌术后并发症43例，其中EN组27例，EN+PN组16例，差异无统计学意义（P?>0.05）。经Logistic回归分析，未发现营养治疗并发症的独立影响因素，但IgG是肺癌术后并发症的保护因素[OlR=0.654（95% CI：0.476，0.898）]。结论 临床应对肺癌术后化疗患者常规予以合理的营养治疗，EN和PN方式各有优势，条件允许时可以优先选择EN+PN的方式实施。

Abstract:

Objective To explore the clinical effects of different nutritional treatments on lung cancer patients undergoing postoperative chemotherapy. Methods From July 2015 to December 2017, 754 patients in the primary screening group who underwent lung cancer surgery and post-operative chemotherapy in the the department of cardiothoracic surgery, The First Affiliated Hospital of Chengdu Medical College were selected as the study subjects. The effects of nutritional therapies which included enteral nutrition and enteral nutrition combined with parenteral nutrition on their nutritional status, immune function and complications were observed. Relationships between those two nutritional treatments or other factors and complications of nutritional therapy or postoperative complications during chemotherapy were analyzed by cox regression. Results Totally 427 patients had been completely followed up during 6 weeks. Among them, there were 301 cases (70.5%) in simple enteral nutrition (EN cohort) and 126 cases (29.5%) in enteral nutrition + parenteral nutrition (EN+PN cohort). There was no statistically significant difference in serum total protein (TP), albumin (ALB), prealbumin (PA), immunoglobulin (IgG, IgA) in two cohorts (P?>?0.05), and the difference of immunoglobulin (IgM) and total lymphocyte count (TLC) was statistically significant (P??0.05). After logistic regression analysis, no independent influencing factor of nutritional therapy complications were found, but IgG was the protective factors of postoperative complications of lung cancer [OlR?=?0.654, (95% CI: 0.476, 0.898)]. Conclusion In the case of postoperative chemotherapy patients with lung cancer, it is clinically necessary to support reasonable nutrition therapy, EN and PN have their own advantages, however, the mode of EN + PN can be preferred to be implemented when the appropriate conditions are available.