肠内营养及睡前加餐在肝硬化患者中的应用效果评价

Application of enteral nutrition and late evening snacks in patients with liver cirrhosis

目的对肝硬化患者应用肠内营养及睡前加餐的方法进行营养干预,评估干预1个月的营养状况、肝功能及并发症情况。方法选择首都医科大学附属北京佑安医院2018年3—9月收治的乙肝肝硬化患者40例,分为营养干预组及对照组各20例。营养干预组按每天25~35 kcal·kg^-1的摄入标准给予整蛋白型肠内营养混悬液进行口服营养补充,同时给予睡前200 kcal碳水化合物为主的加餐。对照组自主饮食,不进行营养干预。结果营养干预组患者干预后与干预前比较,平均上臂肌围及握力增加(P均<0.05);营养不良发生率从65%降至35%(P<0.01);白蛋白及前白蛋白水平升高(P<0.05;P<0.01);腹水及腹腔感染发生率降低(P均<0.01)。干预1月后,营养干预组与对照组比较,平均上臂肌围及握力增加(P<0.05;P<0.01);白蛋白和前白蛋白水平升高(P均<0.01),腹水发生率降低(P<0.05)。营养干预组平均住院时间(9.8±2.4)d,较对照组(12.6±3.7)d明显减低(P<0.01)。结论肠内营养及睡前加餐,能够改善肝硬化患者的营养状态,特别是蛋白质营养不良。

ObjectiveNutritional intervention was carried out in patients with liver cirrhosis by enteral nutrition and bedtime snacks.The nutritional status,liver function,and complications were evaluated. MethodsForty HBV-related cirrhosis patients admitted to our hospital from March 2018 to September 2018 were randomly divided into nutritional intervention group and control group with 20 cases,respectively.Nutrition intervention group was given whole protein enteral nutrition suspension by oral administration according to the daily intake standard of 25-35 kcal·kg^-1,and 200 kcal carbohydrate was added in bedtime.The control group was fed autonomously without nutritional intervention.ResultsAfter intervention,compared with before,the average upper arm muscle circumference and grip strength was increased(all P<0.05);the incidence of malnutrition was decreased from 65% to 35%(P<0.01);the levels of albumin and prealbumin was increased(P<0.05;P<0.01);the incidence of ascites and abdominal infection was decreased(P<0.01). After one month of intervention,compared with the control group,the average upper arm muscle circumference and grip strength was increased(P<0.05;P<0.01),the albumin and prealbumin levels were increased(P<0.01),and the ascites incidence was decreased(P<0.05). The average hospitalization time of nutrition intervention group was(9.8±2.4)days,which was significantly lower than that of control group(12.6±3.7)days(P<0.01). ConclusionEnteral nutrition and bedtime snacks can improve the nutritional status of patients with liver cirrhosis, especially protein malnutrition.