| Background and Purpose:Malignant tumor patients often have malnutrition,and the incidence of malnutrition reported at home and abroad ranges from 31% to 87%.The incidence of malnutrition in gastrointestinal malignancies is the highest.These gastrointestinal cancer patients often need to be given enteral nutrition or even parenteral nutrition support.Giving reasonable and timely nutritional support to patients with nutritional risk of malignancy can improve some nutritional indicators,reduce weight loss,shorten hospital stay and improve clinical outcomes.However,tumor cells use glycolysis as a major means of production and improve the use of fat.Some experts have proposed nutrient support methods to increase the proportion of fat and reduce the proportion of glucose.This low sugar to lipid ratio nutritional support has been widely used in enteral nutrition,known as the cancer ketogenic diet therapy,this therapy has achieved good results;but the low sugar to fat ratio of parenteral nutrition may increase because of the increase in fat ratio The risk of liver damage,etc.,is clinically controversial.In this study,parenteral nutrition(PN)was performed on gastrointestinal cancer patients to observe the effects of low glucose-lipid ratio and normal glucose-lipid ratio on the nutritional status,liver function,blood glucose,complications,and clinical outcomes.Methods:The clinical data of PN-bearing gastrointestinal cancer patients who met the inclusion criteria were retrospectively analyzed.A total of 48 patients with stage IV malignant gastrointestinal tumors were included;both groups were treated with PN 5-14 d,according to PN.The glucose/lipid ratios were in the low glucose/lipid ratio group(glucose-lipid ratio <1)in 30 cases and in the normal glucose/lipid ratio group(glucose-lipid ratio>1)in 18 cases.The nutritional status of the two groups before PN,PN 5d,and PN 14 d was compared.NRS2002 score,hemoglobin,lymphocyte count,percentage of lymphocytes,albumin,transferrin,prealbumin,fibronectin,retinol-binding protein),liver function(alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,Total bilirubin,glutamyl transpeptidase,complications during hospitalization(infective complications such as pulmonary infections,duct infections,etc.),non-infectious complications such as heart failure,myocardial infarction,total complications,etc.),clinical outcomes(hospitalization time,mortality)and other indicators,analysis of the differences between the two groups.Results:1.The PN time in the low-glucose-lipid ratio group was 5-31 days,and the mean value was 8.47±4.833 days,while the PN time in the normal glucose-lipid ratio group was 5-41 days,with a mean of 11.83±9.199 days.The contrast difference was not statistically significant.Significance(P=0.156).2.Hemoglobin,hematocrit,lymphocyte count,lymphocyte percentage,albumin,transferrin,total protein,prealbumin,fibronectin,retinol binding protein,BMI in PN,PN 5d in both groups There was no significant difference between PN 14 d and the time period(P>0.05).3.Differences in hepatic function between alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,total bilirubin,and glutamyl transpeptidase before PN,PN 5d,and PN 14 d in the two groups were not statistically different.Significance(P>0.05).4.The incidence of infectious complications in the two groups was not statistically significant between the two groups(P=0.281);but the incidence of total complications was 13.3%(4/30)in the low-glucose-lipid group.The normal glucose-lipid ratio group was 55.6%(10/18).The total complication rate of the low-glucose-lipid group was significantly lower than that of the normal glucose-lipid group,with a statistically significant difference(P=0.002).5.Comparison of clinical outcomes between the two groups,no death occurred in the low-glucose-lipid group,and 1 death occurred in the normal-glucose-lipid group.There was no significant difference in mortality between the two groups(P=0.375).The duration of hospital stay was 22.87±23.787 d in the low-glucose-lipid group,and 30.89±11.896 d in the normal glucose-lipid ratio group,with no statistically significant difference(P=0.190).Conclusion:1.The short-term use of parenteral nutrition with low glucose-lipid ratio did not increase the incidence of hepatic impairment in patients with malignant gastrointestinal tumors in the tumor-bearing patients;Meanwhile,the total incidence of complications during hospitalization was reduced.2.Parenteral nutrition in the short-term low glucose-lipid ratio group was not better than the normal glucose-lipid group in improving the patient's nutritional status,clinical outcomes,and reducing the incidence of infectious complications. |
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