肝硬化患者围手术期的营养支持  

Perioperative Nutritional Support for Patients with Liver Cirrhosis

作　　者：刘宪玲[1] 吴静[1] 樊代明[1] 苗继延[1] 

机构地区：[1]第四军医大学西京医院消化科,西安710032

出　　处：《中国临床营养杂志》2003年第2期140-143,共4页Chinese Journal of Clinical Nutrition

摘　　要：肝硬化患者常存在营养不良和高分解代谢,手术时应予营养支持。富含支链氨基酸的溶液可抗代谢并刺激肝细胞再生,可作为蛋白质的来源。术后残存肝脏主要利用脂肪酸提供能量。过多的糖可抑制内源性脂肪利用。中链脂肪酸比长链脂肪酸更容易被利用,且不在肝脏沉积,因而更可取。肝硬化患者注射三酰甘油后,游离脂肪酸及甘油有在体内聚集的趋势,因而应间断应用。临床研究表明,肝硬化患者进行大肝叶切除或进行肝移植时,围手术期营养支持有利于患者恢复。营养成分的选择、导管的护理以及对输注液体的限制都是有效的围手术期营养支持的前提,是手术成功的保障。Patients with liver cirrhosis often have malnutrition and increased level of catabolism,which is indicated for nutritional support.Branched chain amino acid is supposed to be the available source of protein,which can inhibit metabolism and stimulate cell regeneration.After operation,liver mainly uses fatty acid as the major supply of energy.And redundant sugar inhibits the use of endogenous fatty acid.Medium-chain fatty acid is more potential than long-chain fatty acids,because it is easier to be used and doesn't deposit in liver.After injection of triglyceride into patients with liver corrhosis,free fatty acid and glycerin trend to aggregate in vivo,which should be administered intermittently.As shown in clinic studies,perioperative nutritional support is beneficial for the recovery of patients who have resection of large lobes of liver or transplantation of liver.The selection of nutritious ingredients,nursing of tubes,and limitation of fluid intake are preconditions of effective perioperative nutriational support and guarantee of successful operation.

关 键 词：肝硬化 围手术期 营养支持 营养不良 脂肪酸 

分 类 号：R657.31[医药卫生—外科学] R459.3[医药卫生—临床医学]