肝移植术后早期营养与应激性高血糖的治疗

目的观察肝移植术后早期不同营养治疗方法对应激性高血糖和围手术期预后的影响,探讨肝移植术后早期更合理的营养治疗方法。方法选择因慢性乙型肝炎或丙型肝炎导致肝功能衰竭或终末期肝硬化行肝移植手术患者172例,回顾性分析在肝移植术后早期采用较高或较低热量标准及血糖控制标准情况下,围手术期并发症和重症监护室(ICU)住院时间等差异。结果肝移植术后早期采用较低热量(83.7~104.6 kJ.k-g 1.-d 1)和增加脂肪供能比例(糖∶脂肪=50%∶35%)的阶梯营养治疗、并保持血糖<8 mm o l/L组,较采用较高热量(125.5~146.4 kJ.k-g 1.d-1)和常规供能比例(糖∶脂肪=55%∶30%)、血糖控制在<12 mm o l/L组患者在本后14 d内每日胰岛素用量减少(P<0.01);术后30 d内感染相关病死率降低(P<0.05),机械通气时间和ICU住院时间缩短(P均<0.05)。两组血清总胆红素水平、伤口和吻合口愈合不良发生率、低血糖发生率、白蛋白总用量等比较差异均无显著性。结论肝移植术后早期采用低热量营养并控制血糖<8 mm o l/L的治疗方式有助于减少术后并发症,且不会影响外科预后。

Management of nutritional support and stress hyperglycemia after orthotopic liver transplantation

OBJECTIVE: To study the influence of different nutritional regimes on the stress hyperglycemia and the outcome after orthotopic liver transplantation, for the purpose of optimizing nutritional regime for early post-operative period. METHODS: One hundred and seventy-two patients who received liver transplantation for chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) induced hepatic function failure or end-stage cirrhosis were enrolled, and the post-operative complications and length of stay in intensive care unit (ICU) were retrospectively analyzed, in regard to high caloric (HC) or low caloric (LC) nutritional regime with their blood glucose controlled to a optimal level. RESULTS: After the liver transplantation, those patients who were supplied with LC (83.7-104.6 kJ.kg(-1).d(-1)), energized stepwise with higher fat ratio (sugar:fat=50%:35%) with blood glucose being maintained <8 mmol/L, had less exogenous insulin requirement (P<0.01), lower infection-related mortality rate (P<0.05), and shortened weaning from mechanical ventilation time and length of stay in ICU (both P<0.05), compared with those who were supplied with HC nutrition (125.5-146.4 kJ.kg(-1).d(-1)) with routine sugar and fat ratio (55%:35%), and blood glucose maintained at the same level. However, there was no significant differences in serum bilirubin contents, incidences of poor healing of incision and anastomosis as well as hypoglycemia, and extrinsic albumin requirement between two groups. CONCLUSION: LC nutrition regime and controlling the blood glucose <8 mmol/L during the early post-operative period may reduce the incidence of post-operative complications without influencing the prognosis.