The Nutritional Status Of Patients Undergoning Allo-HSCT And The Effectiveness Of The Comprehensive Nutritional Interventions On Patients’ Nutrtional Status

Objective:1. To describe the changes of the nutritional status of patients undergoing allogeneichematopoietic stem cell transplantation.2. To explore the factors influencing the nutritional status of patients undergoingallogeneic hematopoietic stem cell transplantation.3. To construct the scheme of “nurse-led comprehensive nutritional intervention”.4. To investigate the effectiveness of nurse-led comprehensive nutritional intervent-ion on the nutritional status of patients undergoing allogeneic hematopoietic stem celltransplantation.Methed: The study was consisted of three parts. PartⅠ: A descriptive study was carriedout in this part.The purposive sampling method was used to select patients who weregoing to receive allogeneic hematopoietic stem cell transplantation at the Department ofHematology of the First Hospital Affiliated to Soochow University from January2013toJuly2013.75patients with hematologic disesase were enrolled into the study.The writtenconsent form was signed and the general information of patients was gathered beforeconditioning regimen. The information about height,weight and PG-SGA were gatheredbefore conditioning regimen,as well as2ndweek and4thweek. At the same time,gatheredthe information of PAB before conditioning regimen and once a week after conditioningregimen until the fifth week.PartⅡ: A phenomenological study was carried out in this part. The purposivesampling method was used to select patients undergoing allogeneic hematopoietic stemcell transplantation from PartⅠ.8patients with hematologic disesase were enrolled intothe study.A semi-structured and face-to-face interview was conducted on8patients.TheColaizzi method of empirical phenomenology was used for data analysis. PartⅢ: The scheme of “nurse-led comprehensive nutritional interventions” wasstructured based on the literature and the results of the first and the second part.29patientswho were going to receive allogeneic hematopoietic stem cell transplantation were selectedin the same hospital from August2013to November2013. The information gathered wasthe same as which in the first part,and patients in this group received “nurse-ledcomprehensive nutritional interventions”.Compared the nutrtional status between the twogroups.Results:1.The PAB level began to rise since conditioning regimen,and it rose to thehighest level in the seconed week, then began to decline. The weight and the BMI hasbeen declining in the four weeks since conditioning regimen.2.29.33%of the patients were malnourished before conditioning regimen.Thepercentage of patients with malnutriton increased to be85.33%in the second and the forthweek.The PG-SGA score in the second week was higher than it before conditioningregimen.The PG-SGA score in the forth week was lower than it in the seconed week,but itis higher than it before conditioning regimen.There was33.3%of the patients with dietaryproblems before conditioning regimen,such as nausea, vomiting, constipation etc.Thepercentage of patients with dietary problems increased to be93.2%in the seconedweek.There was still75.8%of the patients with dietary problems in the forth week.3. The influencing factors of the PAB levels in the seconed week were the patients’age,the style of HSCT,nutrtional support and the use of corticosteroids.The older thepatients,the lower the PAB levels. The PAB levels of patients with related donortransplantation were the lowest. The PAB levels of patients with haploidenticaltransplantation and unrelated donor transplantation were higher.The PAB levels of patientsonly received enteral nutrition were the highest.The PAB levels of patients receivedparenteral combined enteral nutrition were the lowest. The age was the significantinfluencing factor,which could explain the variation of PAB at11.3%level. The PABlevels of patients with acute myelogenous leukemia were the lowest,thePAB evels ofpatients with chronic myelogenous leukemia were the highest in the forth week.4.The nutrition intake of patients was affected by treatment,individual factors andsupport system during allogeneic hematopoietic stem cell transplantation.And the supportsystem inclueded caregiver,clinicians and clinical nutritional management. 5. There were no significant differences in the nutritional status at each time betweenthe two groups.Howeve, the PAB level in the intervention group was higher,the weightloss was lower,the percentage of patients with well-nourished was higer than theinvestigation group at each time.Conclusions: The nutritional status of patients deteriorated and the percentage of patientswith malnutrition increased during allogeneic hematopoietic stem cell transplantation. Thenurse-led comprehensive nutritional interventions could reduce the extent of thedeterioration of nutritional status.And it had certain effect to maintain the nutritional statusof patients.