Gómez Candela C, de Cos Blanco A I, Martínez Olmos M A, Hernández M J, Rodríguez A, Ojeda E, García Bustos J
Unidad de Nutrición Clínica y Dietética, Hospital Universitario La Paz, Madrid, España.
Nutr Hosp. 1997 Sep-Oct;12(5):263-9.
Bone marrow transplant (BMT) implies the treatment with substances which may compromise the nutritional condition, thus increasing the morbido-mortality of these patients. The objective of this study is to evaluate the efficacy of the nutritional support (NS) protocol for patients subjected to a BMT in our center.
55 patients were included (24 men and 31 women), who were subjected to BMT during 1994, with prior chemotherapy depending on the underlying disease. The nutritional condition (NC) was evaluated upon initiation and at the end of the NS, using anthropometric, biochemical, and immunological parameters. The NS was given by total parenteral nutrition (TPN), adapted to the needs, as of the second post-transplant day, until such time that oral nutrition was sufficient to supply the nutritional needs of the patients; oral ingestion was permitted at all times, according to the possibilities of the patient. For the statistical analysis, we used the Student's t test, Pearson's Chi squared test, and Spearman's test, with differences being considered significant for values < 0.05.
The average duration of the TPN was 16 +/- 6 days, with a significantly longer time (p < 0.05) in patients with leukemia. The NC assessment was no different at the beginning and at the end of the NS, although all groups show a drop in the albumin levels at the end with respect to those at the beginning, with this being statistically significant in patients with leukemia (p < 0.05), and with solid tumors (p < 0.01), 14.5% of the patients maintained an acceptable oral ingestion (with 75% having lymphomas), and 34.5% did not show any associated oral ingestion. Te better albumin maintenance was correlated with acceptable oral ingestion (p < 0.05).
Nutritional support of patients subjected to a BMT is effective for maintaining their NC levels. The longest duration of the TPN, the lowest frequency of associated oral ingestion, and the greatest decrease of the serum albumin, levels are seen in those cases which had the most aggressive chemotherapy prior to the BMT, which requires adaptation of the NS in function of the underlying disease. The association of oral ingestion may be beneficial due to its effect on the gastrointestinal tract.
骨髓移植（BMT）意味着使用可能损害营养状况的物质进行治疗，从而增加这些患者的发病率和死亡率。本研究的目的是评估我们中心针对接受BMT的患者的营养支持（NS）方案的疗效。
纳入55例患者（24例男性和31例女性），他们于1994年接受了BMT，之前根据基础疾病进行了化疗。在NS开始时和结束时，使用人体测量、生化和免疫参数评估营养状况（NC）。NS从移植后第二天开始通过全胃肠外营养（TPN）给予，根据需要进行调整，直到口服营养足以满足患者的营养需求；根据患者的情况，随时允许口服摄入。对于统计分析，我们使用了学生t检验、皮尔逊卡方检验和斯皮尔曼检验，差异被认为在值<0.05时具有统计学意义。
TPN的平均持续时间为16±6天，白血病患者的时间明显更长（p<0.05）。NS开始时和结束时的NC评估没有差异，尽管所有组在结束时白蛋白水平相对于开始时均有所下降，白血病患者（p<0.05）和实体瘤患者（p<0.01）的这种下降具有统计学意义，14.5%的患者维持了可接受的口服摄入（75%患有淋巴瘤），34.5%的患者未显示任何相关的口服摄入。更好的白蛋白维持与可接受的口服摄入相关（p<0.05）。
接受BMT的患者的营养支持对于维持其NC水平是有效的。在BMT前进行最积极化疗的病例中，TPN持续时间最长、相关口服摄入频率最低且血清白蛋白水平下降最大，这需要根据基础疾病调整NS。口服摄入的关联可能因其对胃肠道的作用而有益。
