肝硬化围手术期个体化营养支持研究

The Study of Individualized Nutritional Support During Perioperative Period in Patients With Liver Cirrhosis

目的探索不同营养状态的肝硬化患者的营养需求,结合肝功能情况优化营养支持的时机和配方。方法入选肝功能分级为Child A和Child B的拟手术肝硬化患者（n=235）,根据PG-SGA分为中度营养不良组（SGA B级）和严重营养不良组（SGA C级）,给予不同的营养支持方案,评估各种方案对患者营养状态、肝功能和术后并发症的影响。结果中度营养不良的肝硬化患者,术前1天开始给予总热量为20-25 kcal/kg/d（糖脂比1：1）的营养支持是适宜的;严重营养不良的肝硬化患者,营养支持应提前至术前5天,并提高总热量（35-40kcal/kg/d）和糖脂比（2：1）。营养支持应持续至术后5-7天,可改善术后肝功能、减少术后并发症。结论肝硬化患者在围手术期应结合营养状态和肝功能,并据此给予个体化的肠内肠外营养支持时机和配方。

Objective Our study aims to investigate the nutrition needs of patients with hepatic cirrhosis in different nutrition status, and the measures to optimize the time and formulation of nutrition support. Methods 235 patients with hepatic cirrhosis of liver function Child A or Child B to receive operation were divided into two groups： moderate malnutrition（SGA B） and severe malnutrition（SGA C）. Each group was given individualized nutrition support. The outcomes include the nutrition status, liver function and post-operation morbidities. Results For cirrhotic patients with SGA B, total Calories of 20 to 25 kcal/kg/d（Glucose： Lipid of 1：1） starting at 1 day before operation is an optimal nutrition support plan. For Cirrhotic Patients with SGA C, higher total Calories of 30-40 kcal/kg/d（Glucose： Lipid of 2：1） starting earlier at 5 days before operation was an optimal nutrition support plan. The nutrition support should be preserved during 5 to 7 days of post-operation in order to improve the liver function and reduce the complications. Conclusion For cirrhotic patients to receive operation, perioperative nutrition support time and formulation should be individualized according to the nutrition status and liver function.