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摘要: 本文介绍肿瘤治疗的一种新方法-肿瘤营养疗法（Cancer nutrition therapy, CNT）。肿瘤营养疗法是计划、实施并评价营养干预, 以治疗肿瘤及其并发症或身体状况, 从而改善肿瘤患者预后的过程, 包括营养筛查/评估、营养干预（咨询、饮食调整、ONS、EN及PN）、疗效评价（包括随访）三个阶段。Abstract: This paper introduces a new treatment method for cancer, namely, cancer nutrition therapy (CNT). CNT is the planning and delivery of nutrition intervention to treat cancers and their complications and improve therapeutic outcomes. The proposed treatment has three phases: (a) Assessing nutritional status; (b) Providing therapy, ranging from counseling, dietary modification, and oral supplementation to nutrient delivery by tube or parenteral feeding; and (c) Monitoring and follow-up, which are critical to assure that CNT could achieve its goals and appropriate for the dynamic nutritional status of the patient.
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图 1 中国抗癌协会肿瘤营养与支持治疗专业委员会制订的肿瘤患者营养治疗临床路径
Figure 1. Clinical pathway of nutritional therapy for cancer patients recommended by the Cancer Nutrition and Supportive Therapy Committee of the Chinese Anti-Cancer Association
Anticancer treatment generally refers to surgery, chemotherapy, radiotherapy, immunotherapy, and so on. Nutritional therapy particularly refers to oral nutritional supplement (ONS), enteral nutrition (EN), and parenteral nutrition (PN). Nutrition education includes diet guidance, dietary modification and dietary counseling
图 2 肿瘤患者营养干预五阶梯
Figure 2. Five ladders of nutrition intervention for cancer patients
TPN: Total parenteral nutrition; TEN: total enteral nutrition; PPN: partial parenteral nutrition; PEN: partial enteral nutrition; ONS: oral nutritional supplement; Nutrition education includes diet guidance, dietary modification, and dietary counseling
表 1 三大营养素供能比例
Table 1. Proportion of energy supply for the three nutrients
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[1] 石汉平, 凌文华, 李薇.肿瘤营养学.人民卫生出版社, (北京)2012.Shi HP, Ling WH, Li W. Nutritional Oncology. People's health publishing house (Beijing), 2012. [2] 石汉平, 李薇, 齐玉梅, 等.营养筛查与评估[M].人民卫生出版社, (北京)2014. [3] Jones JM. The methodology of nutritional screening and assessment tools[J]. J Hum Nutr Diet, 2002, 15(1):59-71. doi: 10.1046/j.1365-277X.2002.00327.x [4] Ottery FD. Rethinking nutritional support of the cancer patient: the new field of nutritional oncology[J]. Semin Oncol, 1994, 21(6):770-778. http://cn.bing.com/academic/profile?id=5713d18406e1350d1702489f67edd38b&encoded=0&v=paper_preview&mkt=zh-cn [5] 石汉平, 李薇, 王昆华.PG-SGA-肿瘤病人营养状况评估操作手册[M].人民卫生出版社, (北京)2013. [6] 石英英, 张晓伟, 袁凯涛, 等. PG-SGA操作标准介绍[J].中华肿瘤防治杂志, 2013, 20(22): 1779-1782. doi: 10.3969/j.issn.1673-5269.2013.22.019Shi YY, Zhang XW, Yuan KT, et al. SOP of PG-SGA. Chinese Journal of Cancer Prevention and Treatment[J]. Chin J Cancer Prevent Treat, 2013, 20(22):1779-1782. doi: 10.3969/j.issn.1673-5269.2013.22.019 [7] 石汉平.肿瘤新疗法-代谢调节治疗[J].肿瘤代谢与营养电子杂志, 2014, 1(1):3-5. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_zldxyyy201401002Shi HP. Neo-therapy for cancer: Metabolism Regulation[J]. Electron J Metab Nutr Cancer, 2014, 1(1):3-5. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_zldxyyy201401002 [8] 李薇.肿瘤支持治疗新概念[J].肿瘤代谢与营养电子杂志, 2014, 1(1):6-9. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zldxyyy201401003Li W. Novel Concepts of Cancer Supportive Care[J]. Electron J Metab Nutr Cancer, 2014, 1(1):3-5. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zldxyyy201401003 -
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