Nutritional support during radiotherapy for head and neck cancer: the role of prophylactic feeding tube placement.
Nutritional support during radiotherapy for head and neck cancer: the role of prophylactic feeding tube placement.
复制标题
DOI：
10.1188/07.cjon.875-880
复制
发表时间：
2007-12-01
影响因子：
1.1
通讯作者：
Cady, Jormain
中科院分区：
文献类型：
--
作者：
Cady, Jormain
接受头颈部癌症放射治疗的患者体重显著减轻并导致营养不良是公认的和可预防的临床问题。治疗期间与体重减轻相关的发病可能包括脱水、住院、治疗疗效受损和生活质量降低，并可能影响生存率。营养不良对伤口愈合的影响可能会延长治疗后的恢复时间，并增加接受后续挽救手术的患者的发病风险。已经实施了多种干预措施，以帮助改善治疗对体重减轻和营养状况的影响，包括使用经皮内窥镜胃造口术（PEG）管。在治疗开始时预防性放置PEG管的价值越来越被认可，有证据表明患者的结局更好。患者选择的标准尚未完全确定，临床实践中存在大量差异，导致这种支持性干预的使用不足。根据文献综述，治疗期间因体重显著减轻而需要置入治疗性PEG管的患者的发病率高于接受PEG管治疗的患者。了解患者，肿瘤和治疗相关的风险因素，系统地确定患者最有可能受益于预防性PEG管放置是护理的一个重要方面。
Significant weight loss and resultant malnutrition in patients undergoing radiotherapy for head and neck carcinomas are recognized and preventable clinical concerns. Morbidity related to weight loss during treatment may include dehydration, hospitalization, compromised treatment efficacy, and reduced quality of life and may impact survival. Malnutrition effects on wound healing may prolong recovery following treatment and increase the risk of morbidity for those undergoing subsequent salvage surgery. Multiple interventions have been implemented to help ameliorate the impact of treatment on weight loss and nutritional status, including the use of percutaneous endoscopic gastrostomy (PEG) tubes. The value of prophylactic PEG tube placement at treatment initiation increasingly is being recognized, and evidence suggests that patients experience better outcomes. Criteria for patient selection have not been defined completely, and a great deal of variation in clinical practice exists, contributing to underuse of this supportive intervention. According to a literature review, patients who require therapeutic PEG tube placement in response to significant weight loss during treatment suffer greater morbidity than patients who receive PEG tubes prophylactically. Understanding patient-, tumor-, and treatment-related risk factors to systematically identify patients most likely to benefit from prophylactic PEG tube placement is an important aspect of nursing care.