如何调整来恢复化疗引起的胃口下降？

虽然癌症治疗中有靶向药和免疫治疗等这些突破性的治疗方式，但化疗仍然是癌症病人最为常见的治疗措施。然而，很多化疗药物比如顺铂会引起令人痛苦的副作用，其中就包括嗅觉和味觉功能下降，吃饭没胃口。

曾经有研究报道，45%到84%的病人接受化疗后会出现味觉的改变，5%到60%的病人会出现嗅觉改变。不过，癌症病人的嗅觉和味觉丧失经常容易被忽略。如果患者因为味觉和嗅觉的改变而吃东西不够，会导致患者营养不良，不能支持后续的治疗。

既然目前化疗仍是不可或缺的癌症治疗方式，那么对于化疗药引起的嗅觉和味觉丧失，我们该怎么做呢？最近有一篇最新的研究文献探索了这一问题，大家一起解读。

顺铂化疗后，患者丧失了嗅觉和味觉

这项研究里纳入的都是使用顺铂化疗药物的肿瘤患者，他们都罹患支气管癌。这些病人分别使用欧洲嗅觉能力测试和味觉条来测试他们的嗅觉和味觉功能。参与者会通过填写问卷的形式来报道他们的饮食习惯。

所有的参与者在两个时间点接受测试：化疗治疗开始之前，以及化疗两个周期后。

研究的结论非常明确：顺铂化疗药物，可以引起几乎一半的患者出现味觉和嗅觉障碍。化疗后，很多患者认为家常的很多食物没什么味道。根据患者描述，他们吃东西感觉像是吃硬纸板；有时候感觉食物过于甜或者过于苦，甚至口里出现了金属的味道。这些会让患者胃口不佳，营养不良，影响癌症的治疗。

这种嗅觉和味觉丧失会持续多久呢？一般在化疗之后四到七天后最为严重。一般情况下，病人在化疗结束后半年内可能会逐渐恢复。

此外需要注意的是，不仅顺铂会引起味觉改变，能够引起味觉改变的化疗药物还包括卡铂、奥沙利铂、环磷酰胺、氟尿嘧啶和紫杉醇等。

如何调整来恢复胃口？

如果出现了味觉和嗅觉丧失的情况，我们该怎么办呢？

• 首先是食物上的改变，比如多补充一些维生素C或维生素E。多吃一些水果和蔬菜。另外根据病人的情况，适度增加调味品，如盐和香料等。如果感觉口里苦涩，则要避免吃红肉、茶和巧克力，可以吃鸡肉和乳制品等。如果感觉口中有金属味道，则不要接触金属餐具。
• 其次是饮食习惯：在化疗期间注意清淡饮食，不要去吃油腻过重的食物，这样可以比较好地调节自己的味觉。尽量少食多餐，充分咀嚼食物，以刺激更多的味觉细胞。
• 药物方面，如果确实是食欲减退严重，我们可以辅助一些药物，比如甲地孕酮来增强食欲。

希望以上信息可以给大家一些参考，如果实在不能正常进食，就需要使用专门的全营养补充剂，如瑞能、速愈素、倍瑞博和速熠素等，以恢复肿瘤病人的营养，避免体重下降。这样才能更好地面对未来的治疗。

参考文献：K. Drareni, et al., Loss of smell in lung cancer patients undergoing chemotherapy: prevalence and relationship with food habit changes, Lung Cancer (2023).

Background and objectives: Cancer patients undergoing cytotoxic chemotherapies exhibit a series of adverse side effects including smell and taste alterations, which can have a significant impact on their food behavior and quality of life. Particularly, olfactory alterations are often underestimated, although declared as frequent by cancer patients. In the present study, we set out to examine loss of smell in lung cancer patients undergoing chemotherapy and its relationship to food habits.

Material and methods: Forty-four bronchial cancer patients receiving cisplatin and 44 controls age and gender matched participants were tested for olfactory and gustatory functions using the European Test of Olfactory Capabilities and the Taste Strips test. Participants reported their food and dietary habits by filling a self-administered questionnaire. Patients were tested under two different sessions: i) before the beginning of the treatment, and ii) 6 weeks later, after 2 cycles of chemotherapy. Controls were tested under the same protocol with two sessions separated by 6 weeks.

Results and conclusions: The results highlighted decreased smell and taste abilities in almost half of the lung patients‘ group even before the exposition to Cisplatin. On a perceptual level, patients rated typical food odors as less edible compared to controls. Moreover, within the patients‘ group, hyposmics reported using more condiments, possibly as a compensatory mechanism to their decreased sensory abilities. Taken together, these findings showed that loss of smell is prevalent in lung cancer patients and is related to changes in dietary practices including seasoning. Future studies will provide a better understanding of these sensory compensation mechanisms associated with olfactory loss and their effects on food pleasure in this patient population.