골수이식 환자의 영양지원 실태에 관한 연구

A Study on the Status of Nutrition Support in Bone Marrow Transplantation Patients

Recently, the number of patients who received Bone Marrow Transplantation(BMT) has been increased dramatically and the diseases for which BMT if efficacious are increasing. Adequate nutritional card for BMT patients is crucial for the success of BMT because nutritional deficiency could provoke deteriorative effects. However, little is known about nutritional status among BMT patients in Korea. This study was conducted to assess oral and parenteral intake of BMT patients and compare the change of nutritional status before and after BMT. Twenty-two BMT patients who were admitted to the Severance hospital from December in 1995 to September in 1997 participated in the study. Total calorie requirements were calculated for each patients individually and nutritional support for each patients consisted of oral and parenteral feeding. To assess oral intake of BMT patients, each patients recorded the amount of food they have eaten from 6 days before BMT to 28 days after BMT. The medical records of each patients were used to assess parenteral intake. To compare the nutritional status before and after BMT, the results of anthropometric and biochemical test from 14 days before BMT to 28 days after BMT were used. At the time of admission, the patients were in allowable nutritional status and their total calorie intake was 93% of total calorie requirement. When the preparative regimen for BMT was started, the patients' oral intake was dramatically decreased below 400kcal/day. Even though their oral intake was increased after BMT, their oral intake at the 4th week after BMT was only 752kcal/d, which is only 35.8% of total calorie requirement. The patients' mean oral intake during BMT period (from 6 days before BMT to 28 days after BMT) was only 439kcal/d. Although Total Parenteral Nutrition(TPN) was added when the preparative regimen was started, the patients' mean total caloric intake during BMT period was 111% of basal energy expenditure and 83% of total calorie requirement. The mean total protein intake was only 58% of total protein requirement. In the comparison of nutritional status between pretransplant phase and posttransplant phase in BMT patients, their body weight and serum albumin level were significantly decreased(p<0.001). These results show inadequacies in nutritional intake among BMT patients, and indicate the need of TPN during BMT period.