Total parenteral nutrition in bone marrow transplant: What is the appropriate energy level?
Total parenteral nutrition in bone marrow transplant: What is the appropriate energy level?
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DOI：
10.1159/000066513
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发表时间：
2003-01-01
期刊：
影响因子：
3.5
通讯作者：
Paolucci, G
中科院分区：
文献类型：
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作者：
Forchielli, ML;Azzi, N;Paolucci, G
目的：全肠外营养（TPN），建议在骨髓移植（BMT），往往是暂停并发症。我们的目标是确定有效的能量供应量及其对需要BMT的儿童的短期影响。研究方法：回顾性评价了20例接受13例同种异体和7例自体BMT治疗恶性（13例）和非恶性（7例）疾病的儿童（11例男性，9例女性，平均年龄8岁，范围1-18岁）的能量/蛋白质摄入、体重变化、植入时间和TPN、并发症发生率和代谢异常。结果如下：每个儿童接受约72%的规定热量，平均0.87 +/- 0.2 x基础代谢率，1.14 +/- 0.4 g蛋白质/kg/天，176 +/- 34：1非蛋白质热量：氮比。在TPN治疗的35天（范围14-62）内，体重有所改善，此后体重减轻。植入发生在20 +/- 7.5天内。热量摄入和植入时间相关（p = 0.002）。发生10例中心静脉导管感染和12例胃肠道感染。在实验室异常中，10例患者的肝功能检查结果暂时改变，1例胆汁淤积儿童永久改变。8名儿童发生了移植物抗宿主病。五人死于癌症。结论：BMT中TPN提供的能量低于预期，大致覆盖了BMR，具有混合效应。在TPN期间校准能量摄入量，并在恢复喂养期间进行调整，以加快恢复。版权所有（C）2003 S. Karger AG，巴塞尔。
Objectives: Total parenteral nutrition (TPN), recommended during bone-marrow transplant (BMT), is often withheld following complications. We aim to determine the effective amount of energy supplied and its short-term effects in children requiring BMT. Methods: Twenty children (11 males, 9 females, mean age 8 years, range 1-18 years) receiving 13 allogenic and 7 autologous BMT for malignant (13) and nonmalignant (7) diseases, were retrospectively evaluated for energy/protein intakes, weight changes, time to engraftment and on TPN, occurrence of complications, and metabolic abnormalities. Results: Each child received approximately 72% of the prescribed calories, an average of 0.87 +/- 0.2 x basal-metabolic rate, 1.14 +/- 0.4 g protein/kg/day, and 176 +/- 34:1 nonprotein calories:nitrogen ratio. Body weight improved during the 35 days (range 14-62) of TPN, with loss thereafter. Engraftment occurred in 20 +/- 7.5 days. Caloric intake and time to engraftment were related (p = 0.002). Ten central-venous-line and 12 gastrointestinal infections occurred. Among laboratory abnormalities, liver function tests resulted temporarily altered in 10 patients, and permanently in 1 child with cholestasis. Eight children developed graft-versus-host disease. Five died of cancer. Conclusions: The energy supplied with TPN in BMT is less than expected and approximately covers the BMR with mixed effects. Energy intake heeds to be calibrated during TPN and adjusted during feeding resumption to expedite recovery. Copyright (C) 2003 S. Karger AG, Basel.