Sheean Patricia M, Braunschweig Carol A
Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
J Am Diet Assoc. 2007 Aug;107(8):1398-403. doi: 10.1016/j.jada.2007.05.007.
There is a paucity of evidence to guide the initiation of parenteral nutrition administration during hematopoietic stem cell transplantation. The purpose of this study was to explore and compare clinical characteristics during early hematopoietic stem cell transplantation to discern if differences existed between those that had parenteral nutrition initiated and those that did not. Medical records of patients admitted for initial autologous or allogeneic hematopoietic stem cell transplantation from two university transplantation centers were evaluated for this retrospective cohort. A multitude of clinical features were evaluated at baseline and in the days preceding parenteral nutrition initiation to investigate potential differences between parenteral nutrition and non-parenteral nutrition subjects, stratified by donor type. To examine the occurrence of events prior to parenteral nutrition administration, a "before" time frame was created for all subjects. For parenteral nutrition subjects, the actual number of hospital days prior to parenteral nutrition initiation was used; however, for non-parenteral nutrition patients, the transplantation-specific average number of days until parenteral nutrition initiation, depicted as "before" (ie, autologous non-parenteral nutrition "before"=hospital days 1 to 10, allogeneic non-parenteral nutrition "before"=hospital days 1 to 13), was used during this parallel timeframe. Differences were assessed using Student's t and Wilcoxon rank sum tests for continuous variables, and chi(2) for categorical variables. Parenteral nutrition was provided to 53% (n=129/245) of autologous and 65% (n=73/112) of allogeneic patients and was typically initiated on transplant day +6 and day +7, respectively. Significant decreases in oral intake patterns (P<0.0001) and a tendency toward infections were observed for autologous (P=0.01) and allogeneic (P=0.07) parenteral nutrition vs non-parenteral nutrition recipients "before." In addition, significantly more mucositis was observed "before" in allogeneic parenteral nutrition vs non-parenteral nutrition patients (P=0.04). Involvement of nutrition professionals is crucial for the design and implementation of future studies to determine for whom and when to commence parenteral nutrition and to discourage its indiscriminant use.
在造血干细胞移植期间，指导肠外营养支持启动的证据不足。本研究的目的是探索和比较造血干细胞移植早期的临床特征，以辨别接受肠外营养支持和未接受肠外营养支持的患者之间是否存在差异。本回顾性队列研究评估了来自两个大学移植中心的初次接受自体或异体造血干细胞移植患者的病历。在基线以及肠外营养支持开始前的几天，对众多临床特征进行了评估，以调查按供体类型分层的肠外营养支持组和非肠外营养支持组之间的潜在差异。为了检查肠外营养支持开始前的事件发生情况，为所有受试者设定了一个“之前”的时间范围。对于接受肠外营养支持的受试者，使用肠外营养支持开始前的实际住院天数；然而，对于未接受肠外营养支持的患者，在此平行时间范围内，使用移植特异性的直至肠外营养支持开始的平均天数，描述为“之前”（即自体未接受肠外营养支持的“之前”=住院第1至10天，异体未接受肠外营养支持的“之前”=住院第1至13天）。对于连续变量，使用学生t检验和Wilcoxon秩和检验评估差异，对于分类变量，使用卡方检验。53%（n = 129/245）的自体移植患者和65%（n = 73/112）的异体移植患者接受了肠外营养支持，通常分别在移植后第6天和第7天开始。与“之前”未接受肠外营养支持的自体移植（P = 0.01）和异体移植（P = 0.07）患者相比，接受肠外营养支持的患者口服摄入量显著下降（P < 0.0001），且有感染倾向。此外，与未接受肠外营养支持的异体移植患者相比，接受肠外营养支持的患者在“之前”观察到显著更多的粘膜炎（P = 0.04）。营养专业人员的参与对于未来研究的设计和实施至关重要，这些研究旨在确定谁以及何时开始肠外营养支持，并避免其滥用。
