- 期刊
周邊幹細胞移植後移植物抗宿主疾病病人腸胃道功能失調之營養照護
Nutritional Care for a Patient Receiving Peripheral Blood Stem Cell Transplantation With Acute Graft-Versus-Host Disease and Gastrointestinal Complications
摘要
急性移植物抗宿主疾病（acute graft-versus-host disease, aGVHD）是造血幹細胞移植（hematopoietic stem cell transplant, HSCT）後主要的併發症，其免疫反應會導致嚴重的免疫調節異常及器官功能障礙。個案為一位39歲男性經診斷為鼻型結節外NK/T細胞淋巴瘤與肝臟、骨髓浸潤（extranodal natural killer T cells [NK/T]-cell lymphoma, with liver and bone marrow [BM] involvement），並進行周邊血液幹細胞移植（peripheral blood stem cell transplantation, PBSCT），於移植後的第10天發現皮膚紅疹、嚴重腹瀉等急性移植物抗宿主疾病症狀，給予禁食及中央靜脈營養（total parenteral nutrition, TPN）（熱量：30 ～ 35 kcal/kg/day、蛋白質：1.5 ～ 2.0 g/kg/day）；腹瀉症狀改善後，追蹤其進食情形，並依臨床疾病進展給與補充添加魚油之口服營養品。藉由此aGVHD個案之照護過程，探討移植後腸胃道症狀之營養照護重點。
並列摘要
Acute graft-versus-host disease (aGVHD) following hematopoietic stem cell transplant (HSCT) is an immune triggered process, leading to profound immune dysregulation and organ dysfunction. Herein, we present the case of a 39-year-old male patient with extranodal natural killer T cells [NK/T]-cell lymphoma, with liver and bone marrow involvement and lymphoma cutis. After peripheral blood stem cell transplantation (PBSCT), he had skin rash and severe diarrhea, thus aGVHD was suspected. He was prescribed nothing by mouth (NPO) and he started using total parenteral nutrition (TPN) for nutrition support (calories: 30-35 kcal/kg/day; protein: 1.5-2.0 g/kg/day). When the diarrhea was improved, we carefully monitored his oral intake status and a formula containing fish oil had been supplemented. In this report, we shared our experiences of nutrition management of the gastrointestinal complications in a patient with aGVHD.