詹 文 華 等 1 個 案 病 況 ml IVa ( T3N1M1 ) ( squamous cell carcinoma ) ( cisplatin + fluorouracil ( 5-FU ) 5 cgy/25 Fr )

Transcription

1 個 案 報 告 食 道 癌 病 人 治 療 期 間 之 營 養 照 顧 摘 要 ( ) IVa 62 ( induction CCRT ) ( early enteral feeding ) 前 言 % 8% 1 / : : 125 B2 : : [email protected] TJD 21;2(2):45-56 Taiwan Journal of Dietetics

2 詹 文 華 等 1 個 案 病 況 ml IVa ( T3N1M1 ) ( squamous cell carcinoma ) ( cisplatin + fluorouracil ( 5-FU ) 5 cgy/25 Fr ) 營 養 照 顧 過 程 164 CBW % of UBW UBW 76 BMI 26.8 kg/ / / Harries- Benedict 62.4 / 122% CCRT / / / ( ) ( BMI 26.8 kg/ ) ( ) ( % ) ( ) - - 第 一 次 營 養 照 護 ( )

3 21/ 1/26 21/ 2/3 [1stCCRT] 21/ 3/1 [2ndCCRT] 21/ 3/3 21/ 4/2 21/ 4/27 [POD-1] 21/ 4/3 WBC 1,3/ul Hb gm/dl Glucose mg/dl BUN mg/dl CRE mg/dl Uric acid mg/dl Cholesterol mg/dl Albumin g/dl Globulin g/dl Direct/Total Bilirubin mg/dl.19 / / GOT / GPT U/L 18 / / 2 19 / / / 18 3 / 27 Na mmol/l K mmol/l Cl mmol/l Ca mg/dl WBC: white blood cell ; Hb: hemoglobin; BUN: blood urea nitrogen; CRE: creatinine; GOT: glutamic-oxalocetic transaminase; GPT:glutamic-pyruvic transaminase; Na:sodium; K: potassium; Cl: chlorine; Ca:calcium ( ) ( ) ( ) % 2 1 ( / / 1% ) 3-4 c.c / 第 二 次 營 養 照 護

4 詹 文 華 等 EER stCCRT ndCCRT POD POD OPD-start soft diet CCRT concurrent chemoradiation therapy EER estimated energy requirements POD postoperative day OPD outpatient department EPR stCCRT ndCCRT POD POD OPD-start soft diet EEREPR. 48.

5 7.5 BMI 26.2 kg/m hemoglobin, Hb 11.9 ( ) c.c ( / ) / ( % 119% ) / / ( ) ( ) ( ) ( BMI 26.2 kg/m 2 ) ( ) ( % ) ( ) - ( -) ( ) ( ) ( ) 1.5 / 1% c.c. 2 17% 第 三 次 營 養 照 護 T2N1M II b ( ). 49.

6 詹 文 華 等 ( thoracoscopic esophagectomy, gastric tube reconstruction and feeding jejunostomy) BMI 25.5 kg/m 2 Hb Hb 1.5 g/dl glucose 113 mg/dl albumin 3.4 g/dl sliding scale Harries- Benedict / / / ( ) ( BMI 25.5 kg/m 2 ) ( ) ( % ) ( ) - ( - ) ( ) ( ) <5% ( ) / / 5-8 c.c./ /-1%. 5. ( ) 5 +/-1% 5 7

7 PPN Nutriflex-peri 2 cc/day PPN Nutriflex-peri 1 cc/day PPN.IVF F-J cc POD 1D5W 2 cc/hr POD 2 feeding diet.5 kcal/cc cc/hr 8 POD 3feeding diet.75 kcal/cc 6cc/hr 1. kcal/cc 6cc/hr 8cc/hr 8 POD 4feeding diet 1. kcal/cc 8-1 cc/hr 8 POD 5feeding diet >24 kcal/day kcal/cc 1 cc/hr POD esophagography PPN peripheral parenteral nutrition POD postoperative day F/U follow-up F/U. F/U. F/U. F/U

8 詹 文 華 等 POD 1 POD 2 POD 3 POD 4 POD 5/ PPN support + IVF F-J feeding PPN support + IVF F-J feeding POD 1 POD 2 POD 3 POD 4 POD 5/ PPN support + IVF 8 4 F-J feeding PPN support + IVF F-J feeding PPN peripheral parenteral nutrition IVF IV fluid POD postoperative day F-J feeding jejunostomy. 52.

9 ( 3.5% ) 討 論 7 ( early enteral feeding ) ICU 2-6 5% 1% kg (kg) stCCRT ndCCRT post-op OPD-start soft diet OPD-remove F-J CCRT concurrent chemoradiation therapy Pre-op preoperative Post-op postoperative OPD outpatient department F-J feeding jejunostomy. 53.

10 詹 文 華 等 34% 6 1% 1 5% 74% 32% 1% % 44% 6% 5 29 ( society of critical care medicine, SCCM ) American society for parenteral and enteral nutrition, ASPEN [ C ] [ E ] /- 1% ( peripheral parenteral nutrition, PPN ) A B ( ) 結 論. 54.

11 參 考 文 獻 1. Capra S, Ferguson M, Ried K. Cancer: Impact of Nutrition Intervention Outcome- Nutrition Issues for Patients. Nutrition 21;17: Kight CE. Nutrition Considerations in Esophagectomy Patients. Nutr Clin Pract 28;23(5): Gabor S, Renner H, Matzi V, Ratzenhofer B, Lindenmann J, Sankin O, Pinter H, Maier A, Smolle J, Smolle-Jüttner FM. Early enteral feeding compared with parenteral nutrition after oesophageal or oesophagogastric resection and reconstruction. Br J Nutr 25;93(4): Sica GS, Sujendran V, Wheeler J, Soin B, Maynard N. Needle catheter jejunostomy at esophagectomy for cancer. J Surg Oncol 25;91(4): R y a n A M, Rowley S P, H e a l y L A, Flood PM, Ravi N, Reynolds JV. Postoesophagectomy early enteral nutrition via a needle catheter jejunostomy: 8-year experience at a specialist unit. Clin Nutr 26;25(3): Braga M, Gianotti L, Gentilini O, Liotta S, Di Carlo V. Feeding the gut early after digestive surgery: results of a nine-year experience. Clin Nutr 22;21(1): Chen AM, Li BQ, Lau DH, Farwell DG, Luu Q, Stuart K, Newman K, Purdy JA, Vijayakumar S. Evaluating the role of prophylactic gastrostomy tube placement prior to definitive chemoradiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 21;78(4): Cassandra E. Nutrition considerations in esophagectomy patients. Nutr Clin Pract 28;23: McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, Ochoa JB, Napolitano L, Cresci G. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N ). JPEN 29;33(3):

12 詹 文 華 等. 56.