肝移植围手术期营养支持

肝移植已成为治疗终末期肝病最有效的手段.肝移植前后患者一般都有不同程度的营养不良,这严重影响到移植手术的成功率,所以对患者的营养状况进行准确的评估和针对性治疗显的尤为重要.营养支持能够明显改善器官移植患者的预后.     

Nutritional disturbances in Crohn's disease.

A wide range of nutritional disturbances may be found in patients with Crohn''s disease. As more sophisticated tests become available to measure vitamin and trace element deficiencies, so these are being recognized as complications of Crohn''s disease. It is important to recognize nutritional deficiencies at an early stage and initiate appropriate treatment. Otherwise many patients, experiencing what can be a chronic and debilitating illness, may suffer unnecessarily from the consequences of deprivation of vital nutrients.     

营养支持在慢性阻塞性肺疾病中的应用进展

随着社会老龄化,慢性阻塞性肺疾病(COPD)作为常见的老年性肺疾病有明显增多的趋势,因此对COPD的治疗越来越受到重视。在COPD的综合治疗中,营养支持是重要的治疗措施之一。现就近年来国内外有关COPD的营养支持研究进展综述如下。一、营养支持对COPD合并营养不良患者的作用1.COPD     

慢性阻塞性肺疾病的营养缺乏

慢性阻塞性肺疾病(COPD)是全世界范围内威胁人类健康的主要疾病,营养缺乏是COPD患者一个常见的问题,也是关系到其预后的一个独立危险因素.除体重下降外,人体测量指标结合实验室检查的综合判定指标及去脂体重、瘦体重等身体组成的分析对营养缺乏的判定具有一定的价值.目前对COPD营养缺乏的发病机制尚不完全清楚,研究表明除能量/代谢失衡、组织缺氧等因素外,系统炎症及瘦素、食欲素的相互调节可能也参与其发病.在COPD患者营养缺乏的治疗方面,除营养支持外,生长激素、睾丸酮等也可作为一种治疗措施.     

自身免疫性肝病

1.什么叫自身免疫性肝病? 自身免疫性肝病是指由于人体的免疫系统出现紊乱,攻击自身的肝脏组织所造成的一类肝脏炎症性疾病,表现为肝脏功能损伤,如转氨酶、血清胆红素、碱性磷酸酶升高等表现.这类疾病主要包括以肝细胞炎症为主的自身免疫性肝炎(AIH)、以肝脏胆管损害及胆汁淤积为主要表现的原发性胆汁性肝硬化(PBC)和原发性硬化性胆管炎(PSC).     

Alcoholic liver disease

Alcohol is a major cause of liver cirrhosis in the Western world and accounts for the majority of cases of liver cirrhosis seen in district general hospitals in the UK. The three most widely recognised forms of alcoholic liver disease are alcoholic fatty liver (steatosis), acute alcoholic hepatitis, and alcoholic cirrhosis. The exact pathogenesis of alcoholic liver injury is still not clear but immune mediated and free radical hepatic injury are thought to be important. There is increasing interest in genetic factors predisposing to hepatic injury in susceptible individuals. Diagnosis is based on accurate history, raised serum markers such as gamma-glutamyltransferase, mean corpuscular volume, and IgA and liver histology when obtainable. Abstinence is the most important aspect of treatment. Newer drugs such as acamprosate and naltrexone are used to reduce alcohol craving. Vitamin supplements and nutrition are vital while corticosteroids have a role in acute alcoholic hepatitis where there is no evidence of gastrointestinal haemorrhage or sepsis. Liver transplantation has excellent results in abstinent patients with end stage liver disease but there are concerns about recidivism after transplant.     

终末期肝病模型评分对终末期肝病患者肝移植预后的预测价值观察

目的 探讨终末期肝病模型(MELD)评分对肝移植患者早期预后的预测价值.方法 回顾87例行肝移植治疗的终末期肝病患者,计算治疗前MELD评分,并与早期并发症的发生和生存率进行分析.结果 本组87例肝移植患者中各种严重并发症发生率为20.7%,住院28 d和术后3月生存率分别为89.7%和88.5%;非并发症组和生存组MELD评分均值分别为14.6、12.9,有统计学差异(P＜0.05),并发症组和死亡组MELD评分均值分别为21.6、29.4,亦有统计学差异(P＜0.05);与MELD≤15组相比,16～24组和≥25组并发症发生率均显著增加(P＜0.05);但16～24组生存率无统计学差异(P＞0.05),而≥25组生存率明显降低(P＜0.05).结论 终末期肝病患者术前MELD评分值越高.肝移植后早期严重并发症发生率和死亡率越高.高分值MELD(≥25)可能是肝移植患者术后并发症发生与死亡较好的预测指标.