Porayko M K, DiCecco S, O'Keefe S J
Division of Internal Medicine and Gastroenterology, Mayo Clinic, Rochester, MN 55905.
Semin Liver Dis. 1991 Nov;11(4):305-14. doi: 10.1055/s-2008-1040448.
The consequences of malnutrition and impact of nutritional support on the liver transplant patient have not been adequately addressed in clinical research studies. As we have gained experience in assessing patients for transplantation surgery, the risks of malnutrition have been realized. Part of the success of liver transplantation today is related to improved timing of surgery, patient selection, and perioperative management. Malnutrition is one of the adverse risk factors that is potentially reversible and therefore specialized nutritional support techniques should be able to improve postsurgical outcome. However, the performance and interpretation of nutritional research has been impeded by difficulties in separating the effects of liver dysfunction from disturbances secondary to nutritional deficiencies; for example, hypoproteinemia would be a consequence of both. Through the use of multivariate prognostic formulas and development of better nutritional indices for patients with liver disease, it should be possible to identify those patients who will receive the greatest benefit from preoperative and perioperative nutritional support. Furthermore, the kinds of nutritional supplementation having the greatest impact could then be determined.
营养不良的后果以及营养支持对肝移植患者的影响在临床研究中尚未得到充分探讨。随着我们在评估患者进行移植手术方面积累了经验，营养不良的风险已被认识到。如今肝移植成功的部分原因与手术时机的改善、患者选择以及围手术期管理有关。营养不良是潜在可逆的不良风险因素之一，因此专门的营养支持技术应能够改善术后结果。然而，营养研究的开展和解读受到了阻碍，因为难以区分肝功能障碍的影响与继发于营养缺乏的紊乱；例如，低蛋白血症可能是两者共同导致的结果。通过使用多变量预后公式以及为肝病患者开发更好的营养指标，应该能够识别出那些将从术前和围手术期营养支持中获益最大的患者。此外，进而可以确定产生最大影响的营养补充类型。
