【摘要】 目的 探讨海洋肽对恶性肿瘤化学治疗（简称化疗）患者营养状况和免疫功能的影响。 方法 依照纳入排除标准选取2010年3－11月66例恶性肿瘤化疗患者，随机分为试验组和对照组，每组各33例。在正常饮食基础上，试验组和对照组分别服用海洋肽制剂和乳清蛋白制剂21 d，进行肝肾功能、营养状况及免疫指标的测定。 结果 干预前后两组肝肾功及血脂指标差异无统计学意义（Pgt;0.05），且均在正常范围内。试验组干预后体质指数（body mass index，BMI）、上臂围、上臂肌围、总蛋白、白蛋白、球蛋白、前白蛋白（prealbumin，PA）、转铁蛋白较干预前升高有统计学意义（Plt;0.05），而血红蛋白和三头肌皮褶厚度干预前后比较差异无统计学意义（Pgt;0.05）；对照组干预前后各指标差异均无统计学意义（Pgt;0.05）；试验组BMI、PA的前后差值较对照组高（Plt;0.05），而其他指标差值在两组间差异无统计学意义（Pgt;0.05）。两组在干预前后组内比较及组间免疫指标差值比较，差异均无统计学意义（Pgt;0.05）。 结论 海洋肽作为部分氮源应用于恶性肿瘤化疗患者，对患者的内脏蛋白、人体测量等均有一定的营养改善作用，但对免疫功能的影响不明显，尚待进一步研究。【Abstract】 Objective To investigate the effects of marine peptide on the nutritional status and immune function in malignant tumor patients undergoing chemotherapy. Methods According to inclusive and exclusive criteria, 66 malignant tumor patients undergoing chemotherapy from March 2010 to November 2010 were randomized into study group and control group with 33 patients in each group. The patients in the study group were given marine collagen peptide whey protein while those in the control group were given whey protein for 21 days. Liver and kidney function, nutritional status and immune function were observed before and after intervention. Results Liver, kidney function and blood lipids of all the patients were within normal range, and were not significantly different between the two groups before and after intervention (P＞0.05). After intervention, body mass index (BMI), arm circumference, arm muscle circumference, total protein, albumin, globulin, prealbumin (PA), transferring protein of the study group were significantly increased (P＜0.05), but hemoglobin and triceps skinfold thickness had no significant changes (P＞0.05). There was no significant difference of the above parameters in the control group before and after intervention (P＞0.05). The magnitude of change of PA and BMI before and after intervention were higher in the study group than those in the control group (P＜0.05), while the magnitude of change of other parameters before and after intervention showed no significant difference between the two groups (P＞0.05). The immune function showed no significant change in both groups before and after intervention (P＞0.05), and it was also not significantly different between the two groups. Conclusion As part of dietary nitrogen sources, marine peptide can significantly improve nutritional status, including visceral protein and anthropometry in malignant tumor patients undergoing chemotherapy, but it has no significant effect on immune function, which should be further studied in detail.
Objective To explore the generalizability and implementation effectiveness of standardized clinical pathways of food for special medical purpose (FSMP). Methods From November 10, 2023 to November 30, 2023, a pilot study for the standardized clinical pathway of FSMP in medical institutions was conducted at Nanjing Drum Tower Hospital (the Affiliated Hospital of Nanjing University Medical School), Chenzhou First People’s Hospital, and the Second People’s Hospital of Yibin. The hospitalized patients using FSMP in these three hospitals were continuously included to analyze the feasibility and effectiveness of the pathway. Results A total of 99 patients were included. The overall effect evaluation of the pathway showed that the proportion of convenient medical order (96.9%), timely delivery (100.0%), and easy storage (96.9%) were relatively high. The proportion of patients with good compliance was 88.9%, the proportion of patients who achieved treatment goals was 51.5%, and the proportion of patients who suspended the use of FSMP in advance was 19.2%. The incidence of gastrointestinal complications, metabolic complications, and infectious complications in patients were relatively low (<30%), and the median (lower quartile, upper quartile) satisfaction scores for patients, family members, and nurses were all 9.0 (8.0, 10.0) points. There was no statistically significant difference in the process evaluation indicators or satisfaction of FSMP clinical pathways between different prescribing personnel (P>0.05). There was no statistically significant difference in the process evaluation indicators or satisfaction of FSMP clinical pathways between different nutritional support methods (P>0.05). Conclusions The FSMP clinical pathway pilot has performed well in terms of convenience, compliance, satisfaction, with a low incidence of complications. The pathway is effective and safe, and can be widely applied.