Avtor/Urednik		Zver, Samo
Naslov		Pomen podpornega zdravljenja s prehrano pri kritično bolnem hematološkem bolniku
Prevedeni naslov		Role of nutrition in supportive therapy of the hematologic patient
Tip		članek
Vir		Med Razgl
Vol. in št.		Letnik 39, št. Suppl 5
Leto izdaje		2000
Obseg		str. 171-7
Jezik		slo
Abstrakt		In haematological patients, malnourishment is a consequence of reduced food intake, malabsorbtion and metabolic changes. The main etiological factors are therapy with cytostatics, irradiation treatment and the release of some cytokines, which are responsible for the increase of basal metabolism and catabolic predominance in patients. One of the catabolic cytokines is tumor necrosis factor alpha, also known as cachexin. Malnourishment should be promptly recognised and treated. Because many haematological patients suffer from acute gut failure and the introduction of a nasogastric tube may be associated with some serious side effects, we prefer total parenteral nutrition (TPN). TPN as well may be associated with some side effects, especially catheter related sepsis or thrombosis, deep vein thrombosis and volume overload. Another problem associated with TPN is the addition of some drugs, usually heparin or insulin, to the TPN mixtures. In TPN mixture stability of either TPN or drugs may change. In the last decade the value of immunonutrition has increased. With the use of immunonutrition we increase immune system response, especially cellular response. In haematological patients most experiences are gathered with glutamine supplementation. The addition of glutamine in critically ill patients may decrease the infection rate in allogeneic bone marrow transplant recipients.
Izvleček		Podhranjenost je pri hematoloških bolnikih posledica zmanjšanega vnosa hrane, malabsorbcije in presnovnih sprememb. Glavni vzroki za nastanek podhranjenosti so zdravljenje s citostatiki, obsevanje z ionizirajočimi žarki in sproščanje nekaterih citokinov, predvsem TNF-alfa (angl. tumor necrosis factor alpha), ki povečajo bazalni metabolizem in katabolične procese. Ključnega pomena je, da podhranjenost takoj spoznamo in začnemo nadomestno zdravljenje z dodajanjem prehrane. Ker pogosto pri hematoloških bolnikih pride do akutne odpovedi prebavil in ker je uvajanje nazogastrične sonde lahko vezano na številne zaplete, se praviloma odločimo za popolno parenteralno prehrano (PPP). Slednja je lahko prav tako vezana na nekaj zapletov, med katerimi so najpogostejši katetrska sepsa, tromboza katetra in globoke vene ter volumska preobremenitev. Velikokrat v mešanice PPP dodajamo zdravila, predvsem heparin in insulin, kar lahko poruši stabilnost PPP ali zdravila. V zadnjem desetletju se v nadomestnem zdravljenju s prehrano vse bolj uveljavlja pojem imunoprehrane. Z imunoprehrano izboljšamo delovanje imunskega sistema, predvsem celične imunosti. Največ izkušenj pri hematoloških bolnikih imamo z glutaminom, s katerim lahko zmanjšamo število okužb pri bolnikih, zdravljenih z alegorično presaditvijo krvotvornih matičnih celic.
Deskriptorji		HEMATOLOGIC NEOPLASMS CRITICAL ILLNESS NUTRITION DISORDERS PARENTERAL NUTRITION, TOTAL ENTERAL NUTRITION GLUTAMINE HEMATOLOGIC DISEASES