臺灣博碩士論文加值系統

目的：造血幹細胞移植 (hematopoietic stem cells transplantation, HSCT) 為一通稱，包含骨髓移植、周邊血液幹細胞移植、臍帶血移植等。有研究發現體重下降會增加骨髓及血液造血幹細胞移植之成人病患死亡率，而靜脈營養支持可改善病人的營養狀況，但何時該積極介入與是否會增加感染機率，目前並無一致的規律。方法：收集在 2013-2017 年間於高雄榮民總醫院進行骨髓移植的病人，共計 102 位，並分析年齡、性別、感染、診斷疾病、體位測量數據、腹圍、住院天數、移植室天數、100 天內的死亡人數、TPN 使用資料、幹細胞種類比例。結果：在經過骨髓移植過程後，有使用 TPN 的體重平均增加 1.1 公斤，無使用 TPN 的體重平均減少 1.6 公斤，兩組間有顯著的差異 (p=0.01)；感染的機率並不因 TPN 的使用與介入時間的差異或幹細胞來源為自體或異體而增加；白蛋白的變化在有無使用 TPN 兩組間比對雖然有統計上的差異 (p=0.01)，但仍可能有研究上的限制導致結果的差異。結論: TPN 的介入不會增加感染的風險且有助於病人移植期間的體重維持，但對住院天數及移植室天數並無影響。

Purpose:Hematopoietic stem cell transplantation (HSCT) is a general term that includes bone marrow transplantation (BMT), peripheral blood stem cell transplantation (PBSCT), and cord blood transplantation (CBT). Studies have found that weight loss in HSCT patients has been attributed with significant morbidity and mortality. Intravenous nutritional support can improve the patient''s nutritional status, but the use of routine total parenteral nutrition (TPN) remains controversial.Methods:A total of 102 patients who underwent bone marrow transplantation at Kaohsiung Veterans General Hospital during 2013-2017 were analyzed. Age, gender, infection, diagnosis, position measurement data, abdominal circumference, length of hospital stay, number of days in the transplant room, number of deaths within 100 days, data on TPN use, proportion of stem cell types.Result:After the bone marrow transplantation process, the average weight of the TPN was increased by 1.1 kg, and the weight without the TPN was reduced by 1.6 kg. There was a significant difference between the two groups (p=0.01).The probability of infection was not increased by the difference in the use of TPN and the time of intervention or the source of stem cells was autologous or allogeneic; the change in albumin was statistically different (p=0.01) in the presence or absence of TPN. However, there may still be research limitations that lead to differences in results.Conclusion: The intervention of TPN does not increase the risk of infection and contributes to the maintenance of weight during the transplant, but has no effect on the length of hospital stay and the number of days in the transplant room.

中文摘要 I
英文摘要 II
第一章 前言 1
第二章 文獻回顧 5
第一節 骨髓移植的分類與介紹 5
第二節 骨髓移植病患常見的營養困難 8
第三節 骨髓移植病患的營養支持 15
第三章 材料與方法 22
第一節 受試者資料收集 22
第二節 受試者基本資料分析 22
第三節 營養評估 22
第四節 統計分析 23
第五節 分組設計 23
第四章 結果與討論 25
第一節 受試者基本資料 25
第二節 靜脈營養介入對病患預後的影響 26
第三節不同時間點靜脈營養介入對病患營養狀態和預後的影響 33
第四節自體與異體移植對病患營養狀態和預後的影響 38
第五節 研究限制 41
第五章 結論 43
第六章 參考文獻 44
附 件 48

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