肝移植后早期营养支持的评估

背景：大多数肝移植受者移植前后均存在不同程度的营养不良,常规的营养支持治疗方法有肠外营养、肠内营养两种。近年来,营养支持正在向更新、更广的方向发展,代谢调理营养在器官移植中的作用倍受重视。 目的：探索肝移植后早期安全、有效和可行的营养支持治疗方法。 方法：选择肝移植后早期(移植后1~7 d)进行营养支持治疗的受者45例,随机摸球法分成3组,即肠外营养支持组、肠内营养支持组、代谢调理组(肠内营养支持+谷氨酰胺+精氨酸),每组15例,各组营养支持均为等热量和等氮量。通过检测肝功能、测定氮平衡、观察术后营养支持并发症发生等手段,分析比较3种方法的疗效。 结果与结论：纳入患者45例均进入结果分析。与肠外营养相比,肠内和代谢调理营养更能有效地改善受者移植后营养状况,促进移植肝功能恢复;与肠内营养相比,代谢调理营养更有利于改善受者氮平衡,促进蛋白质合成,促进移植肝功能恢复,有其优越性。结果提示,肝移植后早期营养支持治疗,肠内营养和代谢调理营养是安全、有效和可行的。

Evaluation of early nutrition support following liver transplantation

BACKGROUND:Most liver transplantation recipients have various degrees of malnutrition before and after surgery. Conventional nutritional support treatments include parenteral nutrition (PN) and enteral nutrition (EN). Nutrition support has been rapidly developing over the past few years, and metabolic intervention nutrition (MIN) has aroused more attention in organ transplantation field. OBJECTIVE:To investigate the safety, efficacy, and feasible nutritional support treatments at early stage following liver transplantation. METHODS:A total of 45 recipients undergoing nutritional support treatments at the early stage of liver transplantation (1-7 days post surgery) were randomly assigned to PN, EN, and MIN (EN+glutamine+arginine), with 15 patients in each group. The treatments involved equal heat quantity and nitrogen. The curative effects of three treatments were compared by detections of liver function, nitrogen balance, and postoperative complications. RESULTS AND CONCLUSION:A total of 45 patients were included in the final analysis. Compared with EN, PN and MIN more effectively improved nutrition condition of recipients and better ameliorated liver functional recovery. Compared with PN, MIN better facilitated nitrogen balance, promoted protein synthesis and liver functional recovery. Results demonstrated that PN and MIN are safe, effective and feasible early nutrition support treatments following liver transplantation.