造血干细胞移植患者的营养评估与护理对策

目的 评价造血干细胞移植患者的营养状况，并提出相应的护理对策。方法 采用主观全面营养评估法（subjeetive global assessment，SGA）及血清白蛋白（albumen，ALB）测量法，对55例造血干细胞移植患者移植前后的营养状况进行评估。结果 （1）55例患者采用SGA评估法，营养良好者17例（30．9％）、轻中度营养不良者30例（54．4％）、重度营养不良者8例（6．7％）；采用ALB评估法，营养良好者16例（29％）、轻中度营养不良者31例（56．3％）、重度营养不良者8例（6．7％），两种方法比较无统计学意义。（2）两种营养评估结果均显示，造血干细胞移植患者术后营养状况有显著下降（P〈0．01）。结论 SGA评估法无创、简便，能准确反映造血干细胞移植患者的营养状况，是一种较为理想的评估方法，适合护理人员使用；若能结合ALB法，可进一步提高评估的准确性。分析导致患者移植后营养不良的原因，主要与摄入减少、代谢异常、医源性并发症有关；相应的护理对策包括及时评估、尽早预防，加强肠内营养，合理肠外营养和积极预防并发症。

Nutritional Assessment of Patients Receiving Stem Cell Transplantation and Its Nursing Countermeasures

Objective To assess the nutritional status of patients receiving stem cell transplantation(SCT) and introduce the corresponding nursing strategies.Methods The methods of subjective global assessment(SGA) and albumen(ALB) were used to evaluate the nutritional status in 55 patients before and after SCT.Results SCT method showed 17(30.9%) patients with eutrophy,30(54.4%) with low to intermediate malnutrition,8(6.7%) with severe malnutrition;ALB method showed 16(29%) with eutrophy,31(56.3%) with low to intermediate malnutrition and 8(6.7%) with severe malnutrition.No significant difference was observed in the outcomes between the 2 methods.The 2 methods both demonstrated that the nutritional statuses of patients were deteriorated after SCT(P<0.01).Conclusion SGA is a non-invasive,easy to perform method;it is an ideal method which can accurately reflect the nutritional status of patients receiving SCT.If SGA is combined with ALB method,the accuracy of assessment can be further increased.The major causes of malnutrition are reduction of food intake,dysfunction of metabolism and iatrogenic complications.The corresponding nursing strategies include evaluation in time,early prevention,enhancement of enteral nutrition,proper parenteral nutrition and prophylaxis of complications.