个体化营养方案在肝癌肝硬化合并不完全性肠梗阻患者中的应用

Application of individualized nutrition regimen in patients with liver cancer,cirrhosis and incomplete intestinal obstruction

目的探讨1例肝癌肝硬化合并不完全性肠梗阻患者的围手术期个体化营养方案。方法1例肝癌肝硬化合并不完全性肠梗阻患者,通过动态评估患者病情,进行营养筛查、营养评定。联合医生、营养师制定合理的营养支持目标和方案,通过饮食指导、运动指导、心理护理、健康教育对患者及家属进行系统指导,总结并分析治疗结果。结果通过对患者的个体化营养支持,患者胃肠功能恢复,腹部伤口愈合良好,无感染、腹胀等不适,B超显示胸腹水减少。干预后,患者白蛋白35.0g/L,总蛋白62.5g/L,血清前白蛋白62mg/L,血红蛋白86g/L,血白细胞计数5.73×109/L,体重50kg(少量腹水),臂围26cm,小腿围35cm,腹围82cm,三头肌皮褶厚度8.4mm,握力18.8kg。患者体重有小幅度上升,食欲增加,三头肌皮褶厚度、上臂围有小幅度上升,营养状况得到改善。结论合理的、个性化的营养支持疗法能有效改善肝癌患者营养状况,促进患者快速康复。

Objective To explore the perioperative individualized nutritional nutrition regimen in a patients with liver cancer,cirrhosis and incomplete intestinal obstruction.Methods There were 1 patient with liver cancer,cirrhosis and incomplete intestinal obstruction.Through the dynamic assessment of the patient's condition,nutrition screening and nutrition assessment were carried out.Together with doctors and dieticians,reasonable nutritional support goals and programs were developed,and systematic guidance were provided to patients and their families through dietary guidance and health education.The therapeutic effect was summarized and analyzed.Results Through individualized nutritional support,the patient's gastrointestinal function recovered,the abdominal wound healed well,without infection,abdominal distension and other discomfort,and B-ultrasound showed that pleural effusion and ascites decreased.After the intervention,the patient had an albumin of 35.0g/L,total protein of 62.5g/L,serum prealbumin of 62mg/L,hemoglobin of 86g/L,blood leukocytes count of 5.73×109/L,weight of 50kg(small amount of ascites),arm circumference of 26cm,calf circumference of 35cm,abdominal circumference of 82cm,triceps skinfold thickness of 8.4mm,and grip strength of 18.8 kg.There was a small increase in body weight,an increase in appetite,a small increase in triceps skinfold thickness and upper arm circumference,and an improvement in nutritional status.Conclusion Reasonable and individualized nutritional support therapy can effectively improve their status of liver cancer patients and promote their rapid recovery.