重型肝炎肝移植围手术期营养支持48例报告  

Perioperative nutrition support of serious hepatitis underwent liver transplantation :48 cases report

作　　者：曲明[1] 王营[1] 杜英东[1] 尹惠生[1] 史彦芬[1] 张成钧[1] 刘延军[1] 

机构地区：[1]山东烟台解放军107中心医院肝胆外科,264002

出　　处：《器官移植》2011年第6期324-327,364,共5页Organ Transplantation

摘　　要：目的探讨重型肝炎患者肝移植围手术期营养支持的方法及其意义。方法 48例重型肝炎患者,肝移植术前每日补充的热量为33～38kcal/kg(1kcal=4.18kJ),以碳水化合物为主,蛋白质1g/(kg·d)(经口服或静脉摄入)。术后尽早予以肠内营养。术后2d起用百普力500ml/d,每日递增,术后5d改用能全力1500～2000ml/d。并根据病情需要辅以肠外营养进行营养支持,监测血糖、肝功能、肾功能、感染、腹部体征及切口愈合等情况。结果 48例重型肝炎患者中术后存活42例(88%)。4例出现腹胀合并胃潴留,其中2例全身状况恶化、腹内压明显增高而终止肠内营养,改为全胃肠外营养,另2例经减缓输注速度并辅以胃肠动力药物后缓解。3例患者出现腹泻,通过纠正低蛋白血症、降低营养液渗透压、调节肠道微生物环境、减缓输注速度等治疗措施后均好转,继续行肠内营养。全部患者营养支持治疗中未发生呕吐及吸入性肺炎。该组患者术后死亡6例,分别死于肺部感染和(或)肾衰竭者4例,原发性移植肝无功能1例,腹腔感染1例。结论对于重型肝炎肝移植患者,围手术期的胃肠营养支持非常重要,有利于移植肝及其他器官的恢复。Objective To investigate the management of perioperative nutrition support and its signif- icance for serious hepatitis patients underwent liver transplantation. Methods Forty-eight serious hepatitis patients had their calorie intake of 33-38 kcal/kg （1 kcal=4. 18 kJ） per day before liver transplantation, containing carbohydrates and protein 1 g/kg per day through oral or intravenous administration. Enteral nutrition was applied in 48 eases after liver transplantation as soon as possible. Peptison liquid was applied on day 2 after operation with 500 ml/d and increased progressively day by day. On day 5 post-operation, Peptison liquid was switched to nutrison fibre of 1 500-2 000 ml/d. Parenteral nutrition was added according to the patient＇s condi- tions. The blood glucose, liver function, renal function, infection, abdominal sign and wound healing of patients were monitored. Results Forty-two （88 % ） of total 48 patients survived after liver transplantation. Abdominal distension and gastric retention occurred in 4 patients. Instead of enteral nutritional, total parenteral nutrition was applied in 2 patients because of deterioration of systemic status and obvious increased intraabdomihal pressure. The other 2 patients were relieved by slowing down the infusion velocity and using gastrointestinal drug. Diarrhea occurred in 3 patients who were improved after correction of hypoproteinemia, decrease of nutrient osmotic pressure, adjustment of intestinal microbial environment as well as slowing down the infusion speed, and the enteral nutrition was continued. No vomitting or aspirated pneumonia occurred in all the patients during the nutrition support. Four patients died of pulmonary infection and/or renal failure, 1 patient died of primary liver graft nonfunction and 1 patient died of abdominal infection after operation. Conclusion Periopera rive gastrointestinal nutrition support is important for serious hepatitis patients. It is helpful for the recovery of liver graft and other organs.

关 键 词：重型肝炎 肝移植 营养支持 肠内营养 肠外营养 

分 类 号：R575[医药卫生—消化系统]