肿瘤患者临床营养问题及其评估课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,肿瘤患者临床营养问题及其评估,(ppt),肿瘤患者临床营养问题及其评估(ppt),（优选）肿瘤患者临床营养问题及其评估,（优选）肿瘤患者临床营养问题及其评估,目录,肿瘤患者营养不良现状,营养不良对肿瘤预后的影响,营养不良的肿瘤患者治疗现状,肿瘤患者营养评估,目录肿瘤患者营养不良现状,肿瘤患者营养代谢发生改变,Marn Caro MM,Laviano A,Pichard C.Nutritional intervention and quality of life in adult oncology patients.Clin Nutr.2007 Jun;26(3):289-301.,肿瘤患者营养代谢发生改变Marn Caro MM,Lav,肿瘤患者随分期升高，营养摄入量,明显下降，导致体重丢失,Ravasco P,Monteiro-Grillo I,Vidal PM,et al.Cancer:disease and nutrition are key determinants of patients quality of life.Support Care Cancer.2004 Apr;12(4):246-52.,肿瘤患者随分期升高，营养摄入量明显下降，导致体重丢失Rava,众多内科疾病中，肿瘤是营养不良,发生率最高的,Meijers JM,Schols JM,van Bokhorst-de van der Schueren MA,et al.Malnutrition prevalence in The Netherlands:results of the annual dutch national prevalence,measurement of care problems.Br J Nutr.2009 Feb;101(3):417-23.,众多内科疾病中，肿瘤是营养不良发生率最高的Meijers J,近年来多个研究中的肿瘤营养风险,发生率,Yu K,Zhou XR,He SL.A multicentre study to implement nutritional risk screening and evaluate clinical outcome and quality of life in patients with cancer.Eur J Clin Nutr.2013,Jul;67(7):732-7.,近年来多个研究中的肿瘤营养风险发生率Yu K,Zhou X,不同部位肿瘤的营养风险发生率比较,Figure 1.The prevalence of,nutritional risk at admission and,at 2 weeks after admission or,discharge according to the,different sites of primary tumors.,A at admission,B 2 weeks after admission or,discharge.,PAN pancreas,CAR cardiac,STO stomach,ESO esophagus,COL colon,LIV liver,REC rectus,UN lung,BRE breast.,Yu K,Zhou XR,He SL.A multicentre study to implement nutritional risk screening and evaluate clinical outcome and quality of life in patients with cancer.Eur J Clin Nutr.2013,Jul;67(7):732-7.,不同部位肿瘤的营养风险发生率比较Figure 1.The,肿瘤患者发生营养不良,的危险因素,Pressoir M,Desn S,Berchery D,et al.Prevalence,risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres.Br J Cancer.2010 Mar,16;102(6):966-71.,肿瘤患者发生营养不良的危险因素Pressoir M,Des,化疗本身会加重患者的营养不良,Malihi Z,Kandiah M,Chan YM,et al.Nutritional status and quality of life in patients with acute leukaemia prior to and after induction chemotherapy in three hospitals in,Tehran,Iran:a prospective study.J Hum Nutr Diet.2013 Jul;26 Suppl 1:123-31.,化疗本身会加重患者的营养不良Malihi Z,Kandia,目录,肿瘤患者营养不良现状,营养不良对肿瘤预后的影响,营养不良的肿瘤患者治疗现状,肿瘤患者营养评估,目录肿瘤患者营养不良现状,肿瘤患者营养状态与全身炎症水平,密切相关,Gomes de Lima KV,Maio R.Nutritional status,systemic inflammation and prognosis of patients with gastrointestinal cancer.Nutr Hosp.2012 May-Jun;27(3):707-14.,肿瘤患者营养状态与全身炎症水平密切相关Gomes de Li,营养不良的肿瘤患者，化疗相关毒,副作用发生率显著升高,Barret M,Malka D,Aparicio T,et al.Nutritional status affects treatment tolerability and survival in metastatic colorectal cancer patients:results of an AGEO prospective,multicenter study.Oncology.2011;81(5-6):395-402.,营养不良的肿瘤患者，化疗相关毒副作用发生率显著升高Barre,住院期间各种并发症发生率的比较,（有营养风险,vs,无营养风险）,Yu K,Zhou XR,He SL.A multicentre study to implement nutritional risk screening and evaluate clinical outcome and quality of life in patients with cancer.Eur J Clin Nutr.2013,Jul;67(7):732-7.,住院期间各种并发症发生率的比较（有营养风险 vs 无营养风险,肿瘤相关营养不良降低肿瘤患者生,活质量,Marn Caro MM,Laviano A,Pichard C.Nutritional intervention and quality of life in adult oncology patients.Clin Nutr.2007 Jun;26(3):289-301.,肿瘤相关营养不良降低肿瘤患者生活质量Marn Caro M,体重丢失,10%,者，生活,质量显著下,降,Nourissat A,Vasson MP,Merrouche Y,et al.Relationship between nutritional status and quality of life in patients with cancer.Eur J Cancer.2008 Jun;44(9):1238-42.,体重丢失10%者，生活质量显著下降Nourissat A,严重营养不良患者生存率显著低于,无营养不良或轻度营养不良的患者,Barret M,Malka D,Aparicio T,et al.Nutritional status affects treatment tolerability and survival in metastatic colorectal cancer patients:results of an AGEO prospective,multicenter study.Oncology.2011;81(5-6):395-402.,严重营养不良患者生存率显著低于Barret M,Malka,状态和风险,例,数,体重下降,不良反应,RR,（,95%CI,）,a,校正,RR,（,95%CI,）,RR,（,95%CI,）,b,校正,RR,（,95%CI,）,非胃肠道相关,营养不良,无营养支持,有营养支持,195,136,59,1.00,1.08,（,0.50-2.32,）,1.00,0.92,（,0.38-2.22,）,1.00,2.22,（,1.10-4.47,）,1.00,2.95,（,1.36-6.36,）,营养风险,无营养支持,有营养支持,195,140,55,1.00,3.13,（,1.21-8.05,）,1.00,2.88,（,0.86-9.65,）,1.00,0.58,（,0.21-1.58,）,1.00,0.72,（,0.22-2.33,）,胃肠道相关,营养不良,无营养支持,有营养支持,247,103,144,1.00,1.28,（,0.58-2.83,）,1.00,1.40,（,0.47-4.17,）,1.00,0.64,（,0.26-1.55,）,1.00,6.83,（,1.67-27.88,）,营养风险,无营养支持,有营养支持,359,144,215,1.00,1.14,（,0.70-1.86,）,1.00,0.9,（,0.50-1.62,）,1.00,0.33,（,0.18-0.56,）,1.00,0.79,（,0.41-1.52,）,营养支持治疗对体重下降,/,不良反应发生率的影响,RR=,相对危险度；,95%CI=95%,可信限,a,以年龄、性别、分期、手术和放化疗进行校正,b,以年龄、性别、分期和放化疗进行校正,Pan H,Cai S,Ji J,et al.The impact of nutritional status,nutritional risk,and nutritional treatment on clinical outcome of 2248 hospitalized cancer patients:a multi-center,prospective cohort study in Chinese teaching hospitals.Nutr Cancer.2013;65(1):62-70.,状态和风险例体重下降不良反应RR（95%CI）aRR（9,营养支持显著减少化疗相关毒副反,应的发生,Hasenberg T,Essenbreis M,Herold A,et al.Early supplementation of parenteral nutrition is capable of improving quality of life,chemotherapy-related toxicity and body,composition in patients with advanced colorectal carcinoma undergoing palliative treatment:results from a prospective,randomized clinical trial.Colorectal Dis.2010,Oct;12(10 Online):e190-9.,营养支持