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[危重症患者特殊营养与代谢支持指南。更新版。西班牙重症医学与冠心病监护病房学会 - 西班牙肠外与肠内营养学会(SEMICYUC - SENPE)共识:肝衰竭与肝移植]

[Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): liver failure and transplantation].

作者信息

Montejo González J C, Mesejo A, Bonet Saris A

机构信息

Hospital Universitario 12 de Octubre, Madrid, España.

出版信息

Med Intensiva. 2011 Nov;35 Suppl 1:28-32. doi: 10.1016/S0210-5691(11)70006-7.

Abstract

Patients with liver failure have a high prevalence of malnutrition, which is related to metabolic abnormalities due to the liver disease, reduced nutrient intake and alterations in digestive function, among other factors. In general, in patients with liver failure, metabolic and nutritional support should aim to provide adequate nutrient intake and, at the same time, to contribute to patients' recovery through control or reversal of metabolic alterations. In critically-ill patients with liver failure, current knowledge indicates that the organ failure is not the main factor to be considered when choosing the nutritional regimen. As in other critically-ill patients, the enteral route should be used whenever possible. The composition of the nutritional formula should be adapted to the patient's metabolic stress. Despite the physiopathological basis classically described by some authors who consider amino acid imbalance to be a triggering factor and key element in maintaining encephalopathy, there are insufficient data to recommend "specific" solutions (branched-chain amino acid-enriched with low aromatic amino acids) as part of nutritional support in patients with acute liver failure. In patients undergoing liver transplantation, nutrient intake should be started early in the postoperative period through transpyloric access. Prevention of the hepatic alterations associated with nutritional support should also be considered in distinct clinical scenarios.

摘要

肝衰竭患者营养不良的发生率很高,这与肝脏疾病导致的代谢异常、营养摄入减少以及消化功能改变等多种因素有关。一般来说,对于肝衰竭患者,代谢和营养支持应旨在提供充足的营养摄入,同时通过控制或逆转代谢改变来促进患者康复。在重症肝衰竭患者中,目前的认识表明,在选择营养方案时,器官衰竭并非主要考虑因素。与其他重症患者一样,应尽可能采用肠内途径。营养配方的组成应根据患者的代谢应激进行调整。尽管一些作者经典地描述了生理病理基础,认为氨基酸失衡是引发肝性脑病的触发因素和维持因素,但目前尚无足够的数据推荐将“特殊”方案(富含支链氨基酸且芳香族氨基酸含量低)作为急性肝衰竭患者营养支持的一部分。对于接受肝移植的患者,术后应尽早通过经幽门途径开始营养摄入。在不同的临床情况下,还应考虑预防与营养支持相关的肝脏改变。

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