The Prevention And Treatment Of TPN In The Advanced Gastrointestinal Cancer Patients With RFS And The Prescription Analysis

Objective: As the disease progress,the patients with gastrointestinal cancer intake less food gradually,which are not enough to satisfy their physiological requirements.The patients will be suffered from malnutrition,so it is necessary for the patients with advanced cancers to be fed.But feeding blindly is likely to cause the occurrence of re-feeding syndrome?RFS?.The aim of this study is to investigate the prevention and treatment of the total parenteral nutrition?TPN?in the advanced gastrointestinal cancer patients with RFS,who can't eat anything.We also analysis the rationality and the normalization of the TPN prescription,so as to provide the strong support for the individualized prevention and treatment of RFS.Methods:1 According to the risk screening NRS2002 table,the patients would be assessed the nutritional state including nutritional status,disease and age.If the patients' total score were over 3 points,it indicated that the patients were at the greater risk of malnutrition,who should be reefed.New admitted patients with advanced gastrointestinal cancer between January and June 2015 were selected.86 patients met the study criteria.Before re-feeding,it is necessary for us to check the level of the patients' electrolytes,especially the level of potassium,phosphorus,magnesium in the serum.The patients' disorder should be corrected,while intramuscular injection of vitamin B1,and then administration re-feeding with TPN step by step.During the entire re-feeding progress,we monitored the patients' blood electrolytes?potassium,phosphate,magnesium and creatine kinase?.The changes of the patients' body weight were also checked.At the same time,we should observe the incidence of adverse reaction in patients with RFS.2 The retrospective statistical analyses were carried out on 86 patients with TPN during the course of re-feeding,and the rationality and the normalization of TPN were discussed.Results: 1.The prevention and treatment of TPN in the advanced gastrointestinal cancer patients with RFS 1.1 The changes of the serum potassium,serum phosphate,serum magnesium and creatine kinase in the patients with advanced gastrointestinal cancer by TPN for 8 daysFrom the first day of re-feeding,the level of blood potassium,magnesium and phosphorus began to decrease gradually.On the third day,there are significantly differences compared with the first day?P<0.05 or P<0.01?.With the further re-feeding,the content of blood potassium,phosphorus,magnesium increased gradually.Most patients returned to normal levels,compared with the 3d?potassium,phosphorus,magnesium P <0.01?.On the eighth day,the blood potassium level of 96% patients,the blood phosphorus level of 92% patients,and the blood magnesium level of 91% patients returned to normal treatment range.There are no significant differences in serum creatine phosphokinase after re-feeding continuously 8 days.1.2 There are no significant changes of the advanced gastrointestinal cancer patients' body weight by TPN during continuously re-feeding 8 days,which was indicated that there was no significant fluid retention.1.3 The adverse reactions of patients with advanced gastrointestinal cancer by TPN continuously re-feeding 8 daysThere were abnormal ECG 2 cases,abnormal pulmonary rale 1 case,tachycardia and palpitation 2 case,limb pain 1 case.The temperature of 1 patient was up to 37.8 after injecting 4h on the third day,but the temperature returned normal level after finishing injection 2h.The fourth day was similar to the third day.On the fifth day,the above situation disappeared by injected the 1/2 energy.The total incidence rate of adverse reaction was 8.14%.1.4 The obedience of the patients were better.There was no patients who refused the therapy because of the adverse reactions or economic problems.2 Analysis of TPN prescriptions on the advanced gastrointestinal cancer with RFS during continuously re-feeding 8 days 2.1 There were 673 TPN prescriptions of 86 patients with advanced gastrointestinal cancer during the investigating time involve,15 patients were re-feeded by TPN from the third day according their conditions.The male patients were 61 male,and female were 25;age were ranged from 47 to 85,of which more than 47 cases at the age of 60,39 cases less than 60 years old.There were central venous infusion 75 cases,peripheral intravenous infusion 11 cases.2.2 Distribution of heat and nitrogen ratio in patients with advanced gastrointestinal cancerThe number of prescriptions which heat and nitrogen ratio is?100²00?: 1 were 487,accounting for 72.36% in all prescriptions.The number of 100:1 were 109,accounting for 16.20% and the number over 200:1 were 77,accounting for 11.44%.The results show that most of the prescriptions in this study were in the normal proportion.2.3 Distribution of glucose / lipid ratio in patients with advanced gastrointestinal cancerThe number of prescriptions which glucose/lipid ratio is?1²?: 1 were 565,accounting for 83.95% in 673 prescriptions.The number of below 1:1 were 65,accounting for 9.66% and the number over 2:1 was 21,accounting for 3.12%,The number of only includig glucose without lipid were 22,accountig for 3.27%.The results show that most of the prescriptions in this study were also in the normal proportion.2.4 The application of alanyl-glutamine to in patients with advanced gastrointestinal cancerIn the 673 prescriptions,the number of prescriptions injected alanyl-glutamine 10 g were 220,accounting for 32.69%,the number with alanyl-glutamine 20 g were 133,accounting for 19.76% and the number without alanyl-glutamine was 320,accounting for 47.55%.The results mean 52.45% patients were injected alanyl-glutamine in our study.We don't know whether it is suitable for the patients with advanced cancer or not.It should be observed and studied further.2.5 The content of electrolyte which were affecting the stability of TPNIn the 673 TPN prescriptions,there were 574 cases which the Na⁺ concentration was below 100mmol/L and the passing percent is 85.29%,614 cases which the K⁺ concentration was below 50mmol/L and the passing percent is 91.23%,635 cases which the Mg2+ concentration was below 3.4mmol/L and the passing percent is 94.35%,and 668 cases which the Ca²⁺ concentration was below 1.7mmol/L and the passing percent is 99.25%.It showed that the stability of TPN in this research is better.Conclusion:1 The incidence of RFS in the advanced gastrointestinal cancer patients after re-feeding continuously 8 days step by step,is greatly reduced,compared with the epidemiological studies.The adverse reaction rate in our study is 8.14%,but the rate is 42% in epidemiological studies and epidemiological studies.2 The prescriptions of the patients with advanced gastrointestinal cancer are normative.