围手术期肝叶切除术后肝功能失代偿病人的肠外全营养混合液营养支持

The effect of total nutrient abmixture support to the patients with liver function discompensation which after hepatectomy in encircles the surgery time

目的探讨围手术期肝叶切除病人肝功能失代偿进行营养支持的特点,分析营养支持的效果。方法对8例围手术期肝功能失代偿病人的营养状况、营养支持方法和效果进行回顾性分析。结果本组8例病人术前均行营养支持,且8例病人均顺利渡过手术期。8例病人术前存在不同程度的营养不良、肝功能障碍、免疫力偏低,术前营养支持5d后有明显改善(P<0.05);术中发生血糖波动、电解质紊乱;术后出现肝功能失代偿并发症的一系列指征:胆碱酯酶过低、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、谷氨酸转肽酶(GGT)及总胆红素过高、总蛋白及血清蛋白/球蛋白比值过低,同时出现低钾血症、低钠血症、高血糖症、低蛋白血症等。术后营养支持10d,上述症状都得到显著改善(P<0.05),病人体重增加。结论适当的营养支持对围手术期肝功能失代偿肝叶切除病人的康复起重要作用。

Objective To discuss the characteristic of the nutritional support in perioperation phase of hepatectomy patients an analyze the effect of total nutrient abmixture（TNA） support. Method Retrospectively analyze nutritional condition,nutritional support method and their treatment effect of 8 patiens whose liver function is in decompenstation stage. Results Those 8 patient got nutritional support before hepatectomy and live through the operation at last.They were malnutritional and liver function and immunity were poor.After nutritional support for 5 days,they were obviously improved （P〈0.05）. In the operation,those patients suffered from abnormal blood glucose and the electrolyte disorder.After hepatectomy,their liver function were abnormal：low CHE,high ALT and GGT,high TB and TP,low A/G ratio.Then they also experienced hyponatremia,hypopotassaemia,hyperglycemia and hypoproteinemia.These condition were improved obviously after nutritional support for 10 days（P〈0.05）.Their weight incresed at the same time. Conclusion Proper nutritional supporting peri-operation phase is important in recovery of hypatectomy patients.