| Objective Gastrointestinal tumors mainly include colorectal cancer and gastric cancer,whose morbidity and mortality rate rank among the top five in China and even in the world.Patients with gastrointestinal malignancies have a higher rate of malnutrition compared with other types of tumors.As an independent risk factor for cancer patients,malnutrition will directly affect the therapeutic effect,increase the cost of treatment and affect the quality of life of patients.In this study,a prospective randomized,parallel controlled trial was designed to observe the effects of parenteral enteral combined nutrition and enteral nutrition on nutritional indexes,immune function,inflammatory indexes and quality of life in patients with advanced gastrointestinal malignancies malnutrition.To observe the efficacy and safety of these two treatments for patients with advanced gastrointestinal malignancy malnutrition,and to provide objective basis for formulating reasonable and effective nutritional support treatment programs for patients with advanced gastrointestinal malignancy malnutrition,to provide opportunities for comprehensive treatment of subsequent tumors.Methods The total number of cases was 80 according to the sample size estimation formula of the optimal potency measurement data.From May 2021 to November 2022,80 patients with advanced gastrointestinal malignancy and malnutrition in the ward of digestive oncology department of Ruian Hospital of Traditional Chinese Medicine were selected as the research objects.SPSS statistical software was used to give a random table,and the included patients were divided into experimental group and control group.The diet of the two groups after admission was uniformly provided by the nutrition Department of our hospital.The treatment course of control group and experimental group was 3 weeks.Control group:oral nutritional supplements(TPF-1200ml/bottle/250kcal)a daily energy supplement of 20 kcal/kg,divided into 4-6 times a day.Experimental group:①oral nutritional supplements(TPF-1 200ml/bottle/250kcal)a daily energy supplement of 10 kcal/kg,divided into 4-6 times a day.②Supplementary parenteral nutrition(10 kcal/kg energy configuration,The energy ratio of protein,fat and carbohydrate was 0.5:1:1).Nutritional indexes(serum albumin,hemoglobin),immune function indexes(lymphocyte subsets NK,CD4+,CD8+,CD4+/CD8+),inflammatory indexes(white blood cell count,C-reactive protein)were observed before treatment and after 1,2 and 3 weeks.Quality of life score(EORTC QLQ C30)in cancer patients before and after treatment.Incidence of drug-related adverse reactions.Results①There were no significant differences in gender,age,BMI,NRS score and other general data between the two groups(p>0.05).②There was no significant difference in albumin value between the two groups after the first and second weeks of treatment.After 3 weeks of nutritional treatment,the albumin value in 2 groups was significantly higher than before,the difference was statistically significant(p<0.001).After 1,2 and 3 weeks of nutritional treatment,hemoglobin in the two groups was slightly increased,but there was no statistical significance between the two groups(p>0.05).③There were no significant differences in the levels of NK cells,CD4+T cells,CD8+T cells and CD4+/CD8+between the two groups after the first week of treatment(p>0.05).After the 2nd and 3rd week of treatment,there were statistically significant differences in NK cells,CD4+T cells and CD4+/CD8+(p<0.001),but no statistically significant differences in CD8+T cells between the two groups(p>0.05).④There was no significant difference in white blood cell count and C-reactive protein between the two groups after the first week of treatment(p>0.05).After the second week of treatment,there was no significant difference in white blood cell count between the two groups(p=0.263,p>0.05);The difference of C-reactive protein between groups was statistically significant(p<0.001).After 3 weeks of treatment,there were significant differences in leukocyte count and C-reactive protein between the experimental group and the control group(p<0.05).⑤The improvement of life quality of the experimental group was significantly better than that of the control group,and the difference was statistically significant(p<0.05).⑥There was no statistical significance in the occurrence of adverse reactions between the two groups(p>0.05).⑦The liver and kidney function indexes of the experimental group and the control group did not change significantly before and after treatment.Conclusion ①Combined nutrition therapy can effectively improve the malnutrition of patients with advanced gastrointestinal malignancies and improve the body immunity.②Combined nutritional therapy can better reduce the level of inflammatory response and reduce the incidence of infection in patients.③Combined nutrition therapy greatly improved the quality of life of tumor patients without significantly increasing the incidence of adverse reactions.④This study suggests that we should not only pay attention to the supply of nutrients,but also pay attention to the selection of nutritional methods for patients with advanced gastrointestinal malignancies with malnutrition. |
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