McGeer A J, Detsky A S, O'Rourke K
Department of Health Administration, University of Toronto, Ontario, Canada.
Nutrition. 1990 May-Jun;6(3):233-40.
Despite numerous controlled clinical trials, the indications for parenteral nutritional support of cancer patients undergoing chemotherapy remain controversial. The results of the published trials have therefore been subjected to meta-analysis. The pooled data show that total parenteral nutrition (TPN) has a detrimental effect: best estimates associate TPN use with trends to decreased survival (relative risk 0.81; 95% confidence limits [CL] 0.62, 1.0) and poorer tumor response (odds ratio 0.68; 95% CL 0.40, 1.1), with a significant increase in infectious complications (odds ratio 4.1; 95% CL 2.4, 6.9), and no clinically significant effect on gastrointestinal or hematologic toxicity (data not amenable to quantitative analysis). The increased risk of infection persists when catheter-related septicemia is excluded, suggesting that TPN itself may increase susceptibility to infection. In summary, for the patients in trials to date, TPN was associated with net harm. Routine use of TPN in patients undergoing chemotherapy should be strongly discouraged, and trials involving specific groups of patients or modifications in TPN should be undertaken with caution.
尽管进行了大量对照临床试验，但接受化疗的癌症患者肠外营养支持的指征仍存在争议。因此，已发表试验的结果已进行荟萃分析。汇总数据表明，全肠外营养（TPN）有有害影响：最佳估计显示，使用TPN与生存趋势下降（相对风险0.81；95%置信区间[CL]0.62，1.0）和肿瘤反应较差（优势比0.68；95%CL 0.40，1.1）相关，感染并发症显著增加（优势比4.1；95%CL 2.4，6.9），对胃肠道或血液学毒性无临床显著影响（数据不适合定量分析）。排除与导管相关的败血症后，感染风险增加仍然存在，这表明TPN本身可能会增加感染易感性。总之，对于迄今为止试验中的患者，TPN与净危害相关。应强烈不鼓励对接受化疗的患者常规使用TPN，涉及特定患者群体或TPN改良的试验应谨慎进行。
