玫克微朵德国菌菇：恶病质 压死癌症病人的最后1根稻草！这般做，可减轻痛苦
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在<span style="color: black;">全世界</span>癌症晚期<span style="color: black;">病人</span>中，有<span style="color: black;">最少</span>五分之一的<span style="color: black;">病人</span>并非<span style="color: black;">亡于</span>恶性肿瘤本身，而是<strong style="color: blue;">恶病质</strong>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2007年，苹果CEO乔布斯在胰腺肿瘤复发后的短短数月内<span style="color: black;">快速</span>憔悴消瘦。遗憾的是，从乔布斯被诊断出癌症直至去世，恶病质始终未被诊断出来。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="//q4.itc.cn/images01/20240428/33aec5714a4143ebb7a66edfbb04f010.png" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">直肠癌晚期<span style="color: black;">病人</span>“阿健要<span style="color: black;">奋斗</span>活着”<span style="color: black;">经过</span>视频分享了抗癌过程，短短一年的时间，恶病质让精神饱满的三十多岁的小伙子变得骨瘦嶙峋，令人唏嘘心痛。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="//q0.itc.cn/images01/20240428/447a0edf6d2b42169d6ad6e639fdff45.png" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">消瘦被认为是癌症的一部分，是许多癌症和其他绝症<span style="color: black;">病人</span>的<span style="color: black;">最后</span>结果。直到2008年，<span style="color: black;">专家</span>和临床<span style="color: black;">大夫</span>在华盛顿召开会议，才就恶病质的定义达成一致并提出诊断标准。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">当恶病质降临时，癌细胞们像极了一群丧失理智的凶徒，在人体这片土地上肆<span style="color: black;">没</span>忌惮地烧杀抢虐，<span style="color: black;">最后</span><span style="color: black;">引起</span>整块大地的崩塌。<span style="color: black;">那样</span>，<span style="color: black;">到底</span>该怎么理解恶病质？<span style="color: black;">认识</span>到后，又该<span style="color: black;">怎样</span>预防？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">01</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">什么是恶病质？</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">恶病质是一种多<span style="color: black;">原因</span><span style="color: black;">综合症</span>，其特点是不受控的极度<span style="color: black;">减肥</span>和肌肉萎缩，并且可能伴有脂肪的流失，传统的营养支持<span style="color: black;">没</span>法完全逆转，并<span style="color: black;">逐步</span><span style="color: black;">引起</span>功能性<span style="color: black;">阻碍</span>。恶病质<span style="color: black;">重点</span>出<span style="color: black;">此刻</span><span style="color: black;">处在</span>严重<span style="color: black;">疾患</span>状态的<span style="color: black;">病人</span>中，例如癌症、艾滋病、慢性阻塞性肺病、肾脏<span style="color: black;">疾患</span>和充血性心力衰竭。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="//q1.itc.cn/images01/20240428/a37949ed064241c2bf158c3df2a408ca.png" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">02</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">恶病质与恶性肿瘤</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">营养不良的<span style="color: black;">重点</span><span style="color: black;">原由</span>是饥饿，而癌症恶病质<span style="color: black;">是由于</span>肿瘤<span style="color: black;">原因</span>和系统性炎症反应<span style="color: black;">导致</span>的。<span style="color: black;">全世界</span>营养不良领导倡议(Global Leadership Initiative on Malnutrition, GLIM)的共识<span style="color: black;">意见</span><span style="color: black;">运用</span>“癌症恶病质”来确定肿瘤<span style="color: black;">病人</span>的营养不良。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">高达80%的晚期癌症<span style="color: black;">病人</span><span style="color: black;">显现</span>恶病质，<span style="color: black;">全世界</span>超过20%的癌症<span style="color: black;">病人</span>因恶病质而丧命。</strong>恶病质是身体抵抗<span style="color: black;">疾患</span>的反应的一部分。肿瘤组织中的肿瘤细胞和正常细胞分泌的某些因子，会降低<span style="color: black;">病人</span>食欲，<span style="color: black;">乃至</span>完全失去<span style="color: black;">摄食</span>的欲望。癌症及其治疗<span style="color: black;">办法</span>还可能<span style="color: black;">引起</span><span style="color: black;">病人</span><span style="color: black;">显现</span>严重的<strong style="color: blue;">恶心或消化道<span style="color: black;">损害</span></strong>，使其难以<span style="color: black;">摄食</span>和吸收营养。当营养储存不足时，为了<span style="color: black;">得到</span><span style="color: black;">更加多</span>的能量为大脑<span style="color: black;">供给</span>燃料，身体会分解肌肉和脂肪。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="//q5.itc.cn/images01/20240428/381a383799c4488d87ddc0273721b331.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这种<span style="color: black;">繁杂</span>的代谢<span style="color: black;">疾患</span><span style="color: black;">触及</span>组织分解代谢<span style="color: black;">增多</span>、蛋白质合成减少和分解<span style="color: black;">增多</span>。<span style="color: black;">引起</span><span style="color: black;">病人</span>机体功能降低的<span style="color: black;">状况</span><span style="color: black;">显现</span>，<span style="color: black;">病人</span><strong style="color: blue;">极易<span style="color: black;">显现</span>不适感、疲劳和精力不足</strong>的症状。<span style="color: black;">同期</span>，血液中蛋白质含量低可能会<span style="color: black;">引起</span>液体进入组织，<span style="color: black;">引起</span><strong style="color: blue;">肿胀或水肿</strong><span style="color: black;">显现</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">03</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">恶病质<span style="color: black;">归类</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">恶病质前期被定义为在<span style="color: black;">身患</span>已知<span style="color: black;">疾患</span>时体重下降达≤5%。<span style="color: black;">伴同</span>着食欲不振、炎症和新陈代谢的变化。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">恶病质<span style="color: black;">指的是</span>在12个月或更短的时间内体重下降超过5%，或BMI<20 <span style="color: black;">公斤</span>/m2且<span style="color: black;">连续</span>体重下降2%以上，<span style="color: black;">同期</span>存在已知的<span style="color: black;">疾患</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">难治性恶病质适用于<span style="color: black;">身患</span>癌症的人。它<span style="color: black;">指的是</span>体<strong style="color: blue;">重大幅度减轻、肌肉减少、机体性能丧失，并且对抗癌治疗<span style="color: black;">无</span>反应，预期寿命<span style="color: black;">常常</span>少于3个月。</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">04</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">癌症<span style="color: black;">病人</span>恶病质的诊断</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在<span style="color: black;">平常</span>工作中，对癌症<span style="color: black;">病人</span>恶病质的诊断<span style="color: black;">常常</span>是基于<span style="color: black;">食品</span>摄入量的减少。<span style="color: black;">因为</span>癌症<span style="color: black;">病人</span>的病情<span style="color: black;">繁杂</span>，很容易产生误判，<span style="color: black;">由于</span>摄入热量的减少可能是吞咽困难或抑郁症<span style="color: black;">引起</span>的，而不是恶病质的标志。癌症恶病质的诊断很<span style="color: black;">繁杂</span>，<span style="color: black;">因此呢</span><span style="color: black;">必须</span>对病人进行细致的临床<span style="color: black;">检测</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">检测项目<span style="color: black;">包含</span>临床指标：体重、骨骼肌质量、<span style="color: black;">食品</span>摄入日记、活动范围、疲劳程度、生活质量调查、 Karnofsky‘s表现评级，生化指标：血清C反应蛋白、血清纤维蛋白原、血清血细胞比容、血清白蛋白。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">以下6大类人群<span style="color: black;">必须</span><span style="color: black;">警觉</span>恶病质的可能：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">体重严重丢失：</strong>如<span style="color: black;">小于</span>理想体重20％以上，6个月内体重下降超过10％，1个月内体重下降超过5％。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">严重高代谢状态</strong>：如高热、大面积烧伤、严重败血症、重度骨折及恶性肿瘤等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">严重营养素丢失<span style="color: black;">增多</span>：</strong>如肠瘘、开放性创伤、<span style="color: black;">长时间</span>失血、溃疡渗出、严重腹泻及呕吐等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">难以<span style="color: black;">掌控</span>的慢性消耗性<span style="color: black;">疾患</span>：</strong>如恶性肿瘤、糖尿病、心血管<span style="color: black;">疾患</span>、慢性肺部<span style="color: black;">疾患</span>、艾滋病、肝病、肾病、风湿病等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">胃肠道<span style="color: black;">疾患</span>或手术：</strong>如吸收不良、短肠<span style="color: black;">综合症</span>、胃肠道瘘、重症胰腺炎等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">正在<span style="color: black;">运用</span>某些<span style="color: black;">药品</span>或治疗：</strong>如放疗、化疗等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">05</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">恶病质该<span style="color: black;">怎样</span>治疗？</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">做为</span>晚期癌症的一种并发症，对恶病质的治疗<span style="color: black;">必须</span>在<span style="color: black;">掌控</span>原发病灶的<span style="color: black;">同期</span><span style="color: black;">快速</span><span style="color: black;">起始</span>进行。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">除了医疗手段的防治，<span style="color: black;">日前</span><span style="color: black;">科研</span><span style="color: black;">更加多</span>采用营养治疗来<span style="color: black;">掌控</span>恶病质，<span style="color: black;">包含</span><strong style="color: blue;">肠内营养以及肠外营养</strong>两种<span style="color: black;">方法</span>。<span style="color: black;">按照</span>指南<span style="color: black;">举荐</span>，癌症<span style="color: black;">病人</span>首选肠内营养，在肠内营养<span style="color: black;">没</span>法实施（如<span style="color: black;">病人</span>消化功能丧失等），<span style="color: black;">或</span><span style="color: black;">期盼</span>在<span style="color: black;">短期</span>内<span style="color: black;">快速</span>改善<span style="color: black;">病人</span>营养<span style="color: black;">情况</span>的时候，<span style="color: black;">必须</span>采用肠外营养。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">①肠内营养</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">肠内营养指消化道给予特殊医学用途食品，途径<span style="color: black;">包含</span>口服及管饲，后者有鼻胃管、鼻肠管、经皮内镜下胃造口术、 经皮内镜下空肠造口术等。这种<span style="color: black;">方法</span><span style="color: black;">必须</span>在<span style="color: black;">病人</span><span style="color: black;">保存</span><span style="color: black;">必定</span>的消化吸收功能的前提下进行。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="//q0.itc.cn/images01/20240428/c27845115b614a379ed3dd25712f5c8c.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">②肠外营养</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">当<span style="color: black;">病人</span>的肠道<span style="color: black;">已然</span>严重失去功能、<span style="color: black;">没</span>法实施肠内营养或<span style="color: black;">没</span>法完全依赖肠内营养的时候，就<span style="color: black;">必须</span><span style="color: black;">思虑</span>肠外营养了。肠外营养<span style="color: black;">重点</span><span style="color: black;">包含</span>全肠道外营养，<span style="color: black;">亦</span><span style="color: black;">便是</span><span style="color: black;">无</span>其他特定的营养<span style="color: black;">是由于</span>其他路径摄取；以及部分肠外营养，即部分营养还经由肠道摄取。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">指南<span style="color: black;">举荐</span>，肠外营养<span style="color: black;">重点</span>用于预计<span style="color: black;">存活</span>期超过2个月、肠功能衰竭<span style="color: black;">不可</span><span style="color: black;">摄食</span>的<span style="color: black;">病人</span>。但肠外营养依然<span style="color: black;">仅在</span>极<span style="color: black;">少许</span><span style="color: black;">状况</span>下应用，大部分情况下，尤其是<span style="color: black;">针对</span>难治性恶病质<span style="color: black;">病人</span>，肠外营养所带来的不良反应<span style="color: black;">常常</span>大于益处。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="//q4.itc.cn/images01/20240428/46a119a24704416395d1f11403aa8a48.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">③营养<span style="color: black;">弥补</span>素</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">理想<span style="color: black;">状况</span>下，<span style="color: black;">病人</span><span style="color: black;">能够</span>完全<span style="color: black;">经过</span><span style="color: black;">食品</span>来<span style="color: black;">得到</span>重组的营养，<span style="color: black;">然则</span>大<span style="color: black;">都数</span><span style="color: black;">状况</span>下并非如此。氨基酸、脂肪酸、维生素及微量元素等等营养物质的<span style="color: black;">弥补</span>剂应需而生。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">针对</span>这类<span style="color: black;">弥补</span>剂，<span style="color: black;">咱们</span><span style="color: black;">通常</span>不<span style="color: black;">意见</span><span style="color: black;">病人</span><span style="color: black;">自动</span><span style="color: black;">吃下</span>，<span style="color: black;">必定</span>要在营养专家的充分<span style="color: black;">评定</span>之后，根据<span style="color: black;">病人</span>的<span style="color: black;">实质</span><span style="color: black;">状况</span>，“查漏补缺”，让<span style="color: black;">病人</span>既<span style="color: black;">不可</span>缺少、<span style="color: black;">亦</span>不要<span style="color: black;">弥补</span>过度。当然，<span style="color: black;">亦</span><span style="color: black;">能够</span><span style="color: black;">选取</span>癌症家庭都信任的德国复合菌菇<span style="color: black;">弥补</span>剂，除了常规的肠内营养<span style="color: black;">弥补</span>，其中还<span style="color: black;">包括</span>多种活性物质或多种人体<span style="color: black;">必须</span>的营养素物质，完全满足<span style="color: black;">病人</span>对营养的需求。</p>
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