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Children diagnosed with soft tissue sarcoma,
被診斷有軟組織肉瘤、神經母細胞瘤、
neuroblastoma, non Hodgkin’s lymphoma, brain tumors,
非霍奇金淋巴瘤、腦瘤的孩子
male survivors of leukemia, non amputated females
白血病的幸存男士，患有骨癌
with bone cancer, Wilms tumors and survivors of
但沒被截肢的女士和腎母細胞瘤、霍奇金病
Hodgkin’s disease are more likely to be underweight
幸存者在以后的生活中更有可能消瘦不已
later in life whereas children diagnosed with acute
而患有嚴重的淋巴細胞性白血病的孩子
lymphoblastic leukemia and those receiving cranial
和接受顱放射治療的腦瘤患者
radiation therapy for brain tumors were at a higher
極有可能會變得
risk of becoming overweight and even obese.
超重甚至肥胖
The reasons behind these trends are still being
造成這些趨勢的原因
researched however possible implications associated
還在研究之中
with being underweight include being malnourished
但是，與消瘦有關的可能原因有
while receiving total body radiation, treatment with
一是在接受全身輻射和腹部輻射治療時
abdominal radiation and being at a very young age
營養不良，二是在很小的時候
when treatment begins.
就接受治療
The use of aranthrocyclenes and atinomyasin
后期的生活中變得消瘦
which are powerful chemotherapy drugs are also
可能與藥效大的化學藥物—
associated with becoming underweight later in life
aranthrocyclenes和atinomyasin有關
because they cause structural and functional injuries
因為他們會造成胃腸道的結構和功能損傷
to the gastro intestinal tract preventing an adequate
以致在后來的生活中
oral intake even later in life.
口服食物得不到充足的營養
This chart gives an overall comparison of the short
這個圖表對在兒童癌癥時期營養不良的
term and long term consequences of malnutrition during
短期和長期影響做了全面的比較
childhood cancer. The ones that we have already
我們上面討論過的那些副作用是粗體的
discussed are bolded and some other important
另外一些重要的結果包括
consequences include the wasting of muscle and
消耗掉肌肉和脂肪量
fat mass, drug dose alterations, retardation of
藥物用量改變、阻滯了骨骼肌的發展
skeletal muscles and even an increased risk for
甚至增加了二次癌癥的危險
secondary cancers. So clearly avoiding malnutrition
顯而易見，在治療期間避免營養不良
during treatment is extremely important. We will now
是極其重要的
turn our focus to the nutritional interventions that
我們將把注意力轉移到
can be used to avoid malnutrition. We will now turn
可以避免營養不良的
our attentions to the nutritional interventions
營養干預上 這種營養干預最常用在
most commonly used in a clinical setting.
臨床環境中
There are 3 main feeding practices used in healthcare
在醫療保健設施中有三種主要的喂養方式
facilities, supplemental or oral feeding, enteral or
補授法或經口喂養，腸內管飼和
tube feeding and parenteral or IV feeding.
腸內或靜脈注射
Oral feeding is the best method of support for
對營養缺乏不嚴重的病人，
patients with a low nutritional risk. Some children
口服喂養是最好的方式
will still need dietary supplements due to an increase
由于對營養的需求增大，如鈣
in nutrient needs such as calcium. Ideally there
一些孩子通常需要膳食補充劑 理想狀況下
should be flexibility in menu choice and meal times.
對菜單的選擇和吃飯時間應該靈活安排
Studies have shown that a more flexible meal service
研究表明，相比而言靈活的進餐服務對
can lead to a significant increase in children’s food,
孩子們的食物、蛋白質和能量吸收
protein and energy intakes.
有重要的作用
Enteral nutrition is a practical method when oral
兒童在口服營養，體重仍然持續下降時
intake and the weight of a child continue to decrease.
腸內營養是個很實用的方式
Enteral nutrition works well if the child’s gut is
如果兒童的腸道功能如果仍然很好的話
still functioning properly. Enteral feeding also has
那么腸內營養就能起到很好的作用
the advantage of preserving the integrity of the
腸道喂養對于保持腸道粘液的完整也是
intestinal mucousa. Parenteral nutrition is best used
非常有益的 而在兒童腸道功能不再正常
when the child’s gut is no longer functioning
的情況下，腸胃外的營養則是最好的方法
correctly. This bypassing the usual process of eating
這種腸胃外營養是避開正常的進食及消化
and digestion and feeding the child intravenously.
通過對兒童進行靜脈注射來喂養他們
Research has indicated that when normal oral intake
研究表明，在不能正常口服時，腸內營養
is not possible enteral nutrition has more
在生理上比腸胃外營養更具有優勢
physiological benefits compared to parenteral nutrition
這優勢包括保持小腸絨毛
including the maintenance of the heightened activity of
及小腸刷狀緣酶活性的提高
intestinal villi and brush border enzymes,
能更好地保護
better preservation of specific gut nutrients such as
小腸營養內特殊物質
glutamine and short chain fatty acids and an upholding
比如像谷酰酶、短鏈脂肪酸
of the mucosal membrane surrounding the intestine.
和支撐小腸周圍黏膜的薄膜
Enteral nutrition is also associated with fewer
腸內營養也和不少的傳染病
infections and complications however many studies are
以及并發癥相關
continuing to show that parenteral nutrition is more
許多研究不斷表明，腸胃外營養
successful at preventing and correcting malnutrition.
在預防和改善營養不良這方面做的比較成功
