晚期腹膜转移患者在家中开始肠外营养（家庭启动肠外营养，即Home Start PN）的安全性和有效性
Safety and Efficacy of Initiating Parenteral Nutrition at Home, Home Start PN, in Advanced Peritoneal Metastasis.
作者信息
Zhang Chunmeng, Yanala Ujwal, Addula Mounika, Adams Sherry, Ocken Louise, Skiendziel Patricia, Bodkins Tia, Foster Jason M
机构信息
Departments of Surgery, Surgical Oncology, University of Nebraska Medical Center, Omaha, NE 68198, USA.
Department of Internal Medicine, Creighton University Medical Center, Omaha, NE 68124, USA.
出版信息
Cancers (Basel). 2024 Dec 23;16(24):4272. doi: 10.3390/cancers16244272.
BACKGROUND
Patients with peritoneal carcinomatosis often experience intestinal failure throughout the course of their disease, and total parenteral nutrition (TPN) can be used as a temporary solution or as a bridge to definitive cytoreductive surgery. Guidelines for TPN are well established for inpatients and in 2014, guidelines were established for the initiation of TPN for outpatients in a home setting. However, the safety and efficacy of home start TPN in advanced oncology patients remain unknown. This study aims to explore the safety and efficacy of starting TPN in the home setting for patients with peritoneal carcinomatosis.
METHOD
Health records of advanced cancer patients receiving TPN during 2009-2020 were retrospectively reviewed. Data pertaining to diagnosis, demographics, nutritional parameters, and outcomes including hospital readmission rates were collected. Safety was measured based on catheter-related complications and hospital admissions related to electrolyte or fluid imbalance due to TPN. Efficacy was determined by weight gain/stability and pre-albumin and albumin levels. The Fisher's exact and Kruskal-Wallis tests were used to analyze the data.
RESULTS
Seventy TPN patients were identified, of which forty-two were home start (HS) and twenty-eight were in hospital (HP). The two groups were not significantly different in age, (HS: mean = 58.3 ± 13.9; HP: mean = 58.0 ± 13; = 0.95), baseline body weight ( = 0.13), baseline albumin ( = 0.26) or pre-albumin ( = 0.48). At the end of treatment, the HS and HP groups had similar percentages of patients experiencing weight gain/stability (75% vs. 47%, = 0.1), stable/increased pre-albumin (68% vs. 65%, = 1), and stable/increased albumin levels (48% vs. 59%, = 0.58). There was no difference in observed readmission between the groups ( = 0.79). At the end of treatment, 48% of the HS group and 36% of the HP group resumed an oral diet.
CONCLUSIONS
This is the first study to present a comparison between home and hospital start TPN in advanced cancer patients, demonstrating that the initiation of outpatient TPN in the home setting is as safe and efficacious as TPN initiated in the hospital.
背景
腹膜癌患者在疾病过程中常出现肠功能衰竭，全肠外营养（TPN）可作为一种临时解决方案或作为确定性细胞减灭术的桥梁。TPN指南已在住院患者中得到很好的确立，并且在2014年，针对门诊患者在家中开始使用TPN制定了指南。然而，在家中开始使用TPN对晚期肿瘤患者的安全性和有效性仍不清楚。本研究旨在探讨在家中为腹膜癌患者开始使用TPN的安全性和有效性。
方法
回顾性分析2009年至2020年期间接受TPN的晚期癌症患者的健康记录。收集有关诊断、人口统计学、营养参数以及包括住院再入院率在内的结局的数据。基于导管相关并发症以及与TPN导致的电解质或液体失衡相关的住院情况来衡量安全性。通过体重增加/稳定情况以及前白蛋白和白蛋白水平来确定有效性。使用Fisher精确检验和Kruskal-Wallis检验来分析数据。
结果
共确定了70例TPN患者，其中42例在家中开始使用（HS），28例在医院开始使用（HP）。两组在年龄（HS：平均 = 58.3 ± 13.9；HP：平均 = 58.0 ± 13；P = 0.9）、基线体重（P = 0.13）、基线白蛋白（P = 0.26）或前白蛋白（P = 0.48）方面无显著差异。在治疗结束时，HS组和HP组体重增加/稳定的患者百分比相似（75%对47%，P = 0.1），前白蛋白稳定/升高的患者百分比相似（68%对65%，P = 1），白蛋白水平稳定/升高的患者百分比相似（48%对59%，P = 0.58）。两组之间观察到的再入院情况无差异（P = 0.79）。在治疗结束时,HS组48%的患者和HP组36%的患者恢复了口服饮食。
结论
这是第一项比较晚期癌症患者在家中开始和在医院开始使用TPN情况的研究，表明在家庭环境中开始门诊TPN与在医院开始使用TPN一样安全有效。
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