肝移植病人围手术期营养支持治疗

Tactics of perioperative nutritional support in liver transplantation

目的总结肝移植病人围手术期营养支持治疗的经验。方法回顾性分析并对比广州军区广州总医院肝胆外科2003年8月至2006年12月(A组)和2007年1月至2010年3月(B组)两个阶段共205例肝移植病人临床资料、营养支持方法及有关指标。结果 B组术前重度营养不良率为28.2%,显著高于A组(18.9%);B组围手术期注重营养支持并辅以大黄鼻饲、灌肠以及吴茱萸散(自制)外敷脐部,术后肛门排气排便中位时间1.5d、感染并发症发生率32.82%;A组未注重营养支持,术后肛门排气排便中位时间3.5d、感染并发症发生率51.35%。两组差异有统计学意义。结论肝移植围手术期加强营养支持,辅以改善胃肠功能的方法可以提高肝移植病人耐受性、促进胃肠蠕动功能恢复、降低术后感染并发症发生率。

Objective To comprehend the nutritional support methods of the patients with liver transplantation during the perioperation. Methods The clinical data of 205 patients with liver transplantation performed at Guangzhou General Hospital of Guangzhou Command were analyzed retrospeetively. The 205 patients were treated with the nutritional support methods and relevant index between two stages, which were Group A from the August 2003 to December 2006 and Group B from January 2007 to March 2010. Results The rate of the severe malnutrition in Group B before operation was 28.2%, which was higher significantly than Group A （18.9%）. During the perioperation, the patients of Group B were paid more attention to the nutritional support, and were assisted with the nasal feeding or enteroclysis with the Chinese medicine DaHuang and pars umbilicalis spreading with the Chinese medicine WuZhuYu. The middle time of passage of gas and stool by anus after operation in Group B was 3.5 （lays. The incidence of the infection complications was 51.35%. There was significant difference between two groups. Conclusion During the perioperation of the liver transplantation, it could make the patients enhance the toleration, facilitate the gastrointestinal motility, and degrade the postoperative infection by the means of the nutritional support and the improvement of gastrointestinal function.