Abstract: Objective To investigate the changes of nutritional status in pediatric acute lymphoblastic leukemia(ALL) patients during therapies for remission induction with L-asparaginase(L-asp),and to compare the different nutritional status in ALL pediatric patients during therapies for remission induction with L-asp between the regular diet intervention group and the collaborative care model (CCM) diet intervention group. Methods Totally 121 pediatric ALL patients undergoing therapies for remission induction with L-asp in a children's hospital in Shanghai from March 2015 to February 2016 were enrolled in this study and were divided into two groups,with control group from March 2015 to August 2015 and intervention group from September 2015 to February 2016.Patients in control group received the regular diet intervention by nurses.while patients in intervention group received the CCM diet intervention.The nutritional status of the patients was recorded and compared between the two groups. Results During the remission induction with L-asp in pediatric ALL patients,the mid-upper arm circumference,the muscle mass and the serum albumin decreased significantly(P<0.05).The muscle mass of the patients in control group were significantly higher than those in the intervention group(P<0.05) on the first day of L-asp,but there was no significant difference between the two groups on the last day of using L-asp(P>0.05).The change of decrease in mid-upper arm circumferences of the patients in the control group was significantly faster and wider than those in the intervention group(P<0.05). Conclusions The pediatric ALL patients have insufficient energy intake,the loss of fat-free mass and the different levels of hypoproteinemia during the remission induction with L-asp.Nutrition support is suggested to be delivered at the beginning of the therapy.The mid-upper arm circumferences of the patients receiving CCM diet intervention decreased slower than those receiving regular diet intervention.The fat-free mass of the patients receiving the CCM diet intervention lost less than those receiving the regular diet intervention.Therefore,collaborative care model can provide better nutrition support for ALL pediatric patients.

Key words: acute lymphoblastic leukemia, L-asparaginase, collaborative care model, diet intervention, nutritional status

摘要： 目的 了解急性淋巴细胞白血病(ALL)患儿诱导缓解左旋门冬酰胺酶(L-asp)使用期间的营养状况,比较协同护理模式下的饮食干预与常规饮食干预对ALL患儿诱导缓解L-asp使用期间营养状况的影响。方法 选择2015年3月-2016年2月在上海某三级儿童专科医院确诊急性淋巴细胞白血病并进行诱导缓解治疗的121例患儿,以2015年3-8月为对照组,以2015年9月-2016年2月为干预组。对照组由护士进行常规饮食宣教,干预组采用协同护理模式进行饮食干预,比较两组患儿的营养状况。结果 常规饮食宣教指导下,ALL患儿诱导缓解L-asp使用期间上臂围、肌肉量和血清白蛋白显著下降(P<0.05)。L-asp使用开始日,两组肌肉量对照组优于干预组(P<0.05),在L-asp使用末日,两组肌肉量差异无统计学意义(P>0.05)。对照组上臂围的下降速度和幅度显著大于干预组。结论 急性淋巴细胞白血病患儿诱导缓解L-asp使用期间存在能量摄入不足,瘦体组织丢失及不同程度的低蛋白血症,应尽早给予营养支持;相较于传统的饮食宣教,协同护理模式下的饮食干预能减缓上臂围的下降速度和幅度,能减少患儿瘦体组织的消耗,可以为患儿提供更好的营养支持。

关键词: 急性淋巴细胞白血病, 左旋门冬酰胺酶, 协同护理模式, 饮食干预, 营养状况