Pille S, Böhmer D
Klinik für Strahlentherapie, Humboldt-Universität Berlin.
Strahlenther Onkol. 1998 Nov;174 Suppl 3:52-5.
Until today, 25 to 50% of ill or severely disabled patients show qualitative or quantitative nutritional deficits which can lead to a disease aggravation and thus may be a limiting factor in oncologic treatment strategies. Therefore the various options for artificial nutrition should be used according to strict indications. These are whenever the patient is not able to eat (e.g. acute mucositis), does not want to eat (e.g. nausea Grade 3 to 4) or is not allowed to eat (e.g. pancreatitis).
The principle is to apply as much as possible enteral feeding because of its advantages. Enteral nutrition is more physiological, safer and more reasonable. A prerequisite for an adequate feeding is the optimal nutrient composition and detection of patient's individual nutritional status. Numerous options for the adequate application technique of nutritional support are available: 1. oral diets with commercially available supplement drinks; 2. the pump-assisted application by using nasal or percutaneous probes bears many advantages when some important basic rules are not neglected to guarantee a complication free course, e.g. the choice of right nutrients for the right indications, the control of the tube-position and a smooth build-up of the application; 3. peripheral or central venous application is necessary if contraindications prevent the use of enteral nutrition (e.g. ileus, pancreatitis). The following parameters have to be taken into account when generating a parenteral nutrition programme: diagnosis, the present status of the patient's disease, the actual body weight and ideal weight, the laboratory test results, the need of total energy of nutrients in detail and of fluid and electrolytes.
The prevention of malnutrition by adequate therapies for patients with anorexia or cachexia may contribute to a reduction of morbidity and mortality in cancer therapy. There is also a substantial impact of malnutrition on the outcome of anti cancer therapies. Finally a large decrease in health care costs may result from a prevention of cachexia.
直至今日，25%至50%的患病或重度残疾患者存在定性或定量的营养缺乏，这可能导致病情加重，进而可能成为肿瘤治疗策略中的一个限制因素。因此，应根据严格指征使用各种人工营养方法。这些指征包括患者无法进食（如急性粘膜炎）、不想进食（如3至4级恶心）或不允许进食（如胰腺炎）的情况。
原则是尽可能采用肠内喂养，因为其具有诸多优点。肠内营养更符合生理需求、更安全且更合理。充足喂养的一个前提是最佳的营养成分和对患者个体营养状况的检测。有多种营养支持的适当应用技术可供选择：1. 搭配市售补充饮料的口服饮食；2. 使用鼻饲或经皮探针进行泵辅助应用，若不忽视一些重要的基本规则以确保无并发症发生，例如为正确指征选择合适的营养素、控制导管位置以及平稳建立应用过程，则具有诸多优点；3. 如果存在禁忌证妨碍使用肠内营养（如肠梗阻、胰腺炎），则需要进行外周或中心静脉应用。制定肠外营养方案时必须考虑以下参数：诊断、患者疾病的当前状况、实际体重和理想体重、实验室检查结果、详细的营养素总能量需求以及液体和电解质需求。
通过对厌食或恶病质患者进行适当治疗来预防营养不良，可能有助于降低癌症治疗中的发病率和死亡率。营养不良对抗癌治疗的结果也有重大影响。最后，预防恶病质可能会大幅降低医疗保健成本。
