慢性重型病毒性肝炎患者的营养状况分析及营养干预

Nutrition Analysis and Intervention in Patients with Severe Chronic Viral Hepatitis

目的比较分析慢性重型病毒性肝炎患者(慢重肝)与肝炎后肝硬化患者(肝硬化)入院时的膳食营养素摄入量和营养不良指标,以指导慢重肝的营养评价和营养支持,提高其存活率。方法称重记录60例慢重肝和60例肝硬化患者入院时的膳食营养素摄入量,同时测量和检测两组患者营养评价相关指标,经社会科学统计软件包(SPSS11.5)统计处理并比较。结果与中国居民膳食营养素推荐摄入量(RNI)或适宜摄入量(AI)比较,慢重肝组膳食营养素摄入不足的人数为55.93±2.67(93.20%±4.54%),其中摄入严重不足的人数为45.67±7.32(76.20%±12.18%);而肝硬化组分别为26.07±13.74(43.46%±22.76%)和5.13±10.54(8.60%±17.65%),两组比较P<0.01;慢重肝组三头肌皮褶厚度(TSF)测量值显著低于肝硬化组,P<0.05;白蛋白(ALB)、血红蛋白(HB)和钙(Ca)的检测值显著高于肝硬化组,P<0.05;前白蛋白(PA)和运铁蛋白(TRANS)检测值显著低于肝硬化组,P<0.05。结论慢重肝患者的各种膳食营养素摄入量严重不足,能量-蛋白质营养不良问题比肝硬化患者更为严重,营养干预需要将膳食与肠内和肠外营养相结合,早期、全面地补充各种营养素。

Objective To analyze the acquirement of nutrient and the statement of malnutrition in patients with chronic severe viral hepatitis and to direct the nutritional evaluation and the nutritional support in treatment to enhance survival rate. Methods Record the diet intake and assay the correlative perameters of nutrional assessment of 60 cases of chronic severe hepatitis and a control group of 60 cirrhosis cases. State these perameters with SPSSll. 5. Results Compared with RNI or AI, 93.20% ± 4.54% patients of chronic severe hepatitis are deficient in diet intake, 76.20% ± 12. 18% of whom are severe deficient; Compared with the group of cirrhosis 43.46% ± 22.76% and 8.60% ± 17.65%, P 〈 0. 01 ; Chronic severe hepatitis patients have lower TSF than the control, P 〈 0. 05 ; The values of ALB, HB, and Ca are higher while PA and TRANS are distinctively lower than the control. Conclusions Patients suffering from chronic severe hepatitis are generally deficient in diet intake. Energy-protein malnutrition in patients with chronic severe hepatitis is more serious than that in cirrhosis patients. Patients with chronic severe hepatitis should be supplied with all the nutrients timely, nutritional assessment should be combined with diet parenteral and enteral nutrition.