摘要
肿瘤患者常伴蛋白质和葡萄糖代谢异常、癌因性疲乏、高凝状态、抑郁焦虑症、癌症疼痛、发热、消化道梗阻、胸腹腔积液及皮下水肿等,积极处置这些肿瘤相关综合征是肿瘤营养代谢内科不可或缺的部分。例如,依据胃肠道功能补足热量营养素,联合代谢调节治疗和抗肿瘤药物治疗,可逆转骨骼肌丢失;葡萄糖代谢异常可通过减少葡萄糖供给,提高脂肪能量来源比率,使甘油部分取代葡萄糖来改善;对因和对症治疗可缓解癌因性疲乏;低分子肝素等可降低静脉血栓栓塞症发生;抑郁焦虑需筛查评估;对癌痛者行规范化全程管理;消化道梗阻者,需降低胃肠压力联合消除梗阻部位水肿、减少肠腔液体分泌、营养支持、代谢调节及抗肿瘤治疗等;浆膜腔积液者,应用利尿剂,局部腔内注射血管抑制剂。本临床路径着重论述营养代谢技术治疗肿瘤相关综合征,旨在为广大临床医师、临床营养师等提供相应治疗流程,希望为其提供有益的借鉴。
Cancer patients are often accompanied by abnormal protein and glucose metabolism,cancer related fatigue,hypercoagulability,depression,anxiety,cancer pain,fever,gastrointestinal obstruction,pleural and peritoneal effusion,and subcutaneous edema.These cancer-associated syndromes can be managed through nutritional metabolic therapy.The skeletal muscle loss can be reversed supplement of calorie nutrients,combined with metabolic regulation and anti-tumor treatment;the abnormal glucose metabolism can be alleviated by reducing glucose supply,increasing fat energy source ratio and using glycerol to partially replace glucose;causal and symptomatic treatment can relief cancer related fatigue;low molecular weight heparin can reduce the incidence of venous thromboembolism;screening and evaluation are needed for depression and anxiety and the standardized whole-process management is required for cancer pain.For gastrointestinal obstruction need to reduce gastrointestinal pressure and eliminate obstruction edema,reduce intestinal fluid secretion,nutritional support,metabolic regulation and anti-tumor therapy.Diuretics and local cavity injection of vascular inhibitors are applicable to treat serous cavity effusion.This clinical pathway focuses on the treatment of cancer-associated syndromes with nutrition metabolism technology,which provides reference for clinician and clinical dietitians.
作者
吴丹
李苏宜
WU Dan;LI Su-yi(Anhui Provincial Cancer Hospital,The First Affiliated Hospital of University of Science and Technology of China(West Campus),Hefei 230031,China)
出处
《肿瘤学杂志》
CAS
2022年第12期998-1002,共5页
Journal of Chinese Oncology
关键词
营养
代谢
治疗
肿瘤相关综合征
nutrition
metabolism
treat
cancer-associated syndromes
作者简介
通信作者:李苏宜,E-mail:njlisuyi@sina.com
