Yeon Seo Eun, Kim Sun Jung, Kim Ju Hee, Chung Hae-Yun, Na Se Hee, Lee Song Mi
Department of Nutrition Care, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
Department of Nutrition Services, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea.
Clin Nutr Res. 2017 Apr;6(2):136-144. doi: 10.7762/cnr.2017.6.2.136. Epub 2017 Apr 18.
A 30-year-old female patient, 18 weeks gestational age, with no prior medical history was admitted to hospital complaining severe right upper quadrant pain. The patient was admitted to intensive care unit (ICU) after emergency surgery to treat intraperitoneal hemorrhage caused by rupture of liver hematoma. Despite the absence of high blood pressure, the patient was diagnosed with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome on the basis of abnormal levels of blood aspartate aminotransferase/alanine aminotransferase, lactate dehydrogenase, total bilirubin, direct bilirubin, C-reactive protein (CRP) and platelet along with liver damage and proteinuria. While in ICU, the patient was given total parenteral nutrition (TPN) and enteral nutrition (EN) for -20 days because oral feeding was impractical. In the early stage, TPN supply was not sufficient to meet the elevated nutritional demand induced by disease and surgery. Nevertheless, continuous care of nutrition support team enabled satisfactory EN and, subsequently, oral feeding which led to improvement in patient outcome.
一名30岁的女性患者,孕18周,既往无病史,因严重右上腹疼痛入院。该患者在接受紧急手术后被送入重症监护病房(ICU),以治疗肝血肿破裂引起的腹腔内出血。尽管患者没有高血压,但根据血液中天门冬氨酸氨基转移酶/丙氨酸氨基转移酶、乳酸脱氢酶、总胆红素、直接胆红素、C反应蛋白(CRP)和血小板水平异常,以及肝损伤和蛋白尿,该患者被诊断为溶血、肝酶升高和血小板减少(HELLP)综合征。在ICU期间,由于无法进行口服喂养,患者接受了20天的全胃肠外营养(TPN)和肠内营养(EN)。在早期,TPN供应不足以满足疾病和手术引起的营养需求增加。然而,营养支持团队的持续护理实现了令人满意的EN,随后进行了口服喂养,从而改善了患者的预后。