【摘要】 目的 探討海洋肽對惡性腫瘤化學治療（簡稱化療）患者營養狀況和免疫功能的影響。 方法 依照納入排除標準選取2010年3－11月66例惡性腫瘤化療患者，隨機分為試驗組和對照組，每組各33例。在正常飲食基礎上，試驗組和對照組分別服用海洋肽制劑和乳清蛋白制劑21 d，進行肝腎功能、營養狀況及免疫指標的測定。 結果 干預前后兩組肝腎功及血脂指標差異無統計學意義（Pgt;0.05），且均在正常范圍內。試驗組干預后體質指數（body mass index，BMI）、上臂圍、上臂肌圍、總蛋白、白蛋白、球蛋白、前白蛋白（prealbumin，PA）、轉鐵蛋白較干預前升高有統計學意義（Plt;0.05），而血紅蛋白和三頭肌皮褶厚度干預前后比較差異無統計學意義（Pgt;0.05）；對照組干預前后各指標差異均無統計學意義（Pgt;0.05）；試驗組BMI、PA的前后差值較對照組高（Plt;0.05），而其他指標差值在兩組間差異無統計學意義（Pgt;0.05）。兩組在干預前后組內比較及組間免疫指標差值比較，差異均無統計學意義（Pgt;0.05）。 結論 海洋肽作為部分氮源應用于惡性腫瘤化療患者，對患者的內臟蛋白、人體測量等均有一定的營養改善作用，但對免疫功能的影響不明顯，尚待進一步研究。【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.