Shronts E P, Teasley K M, Thoele S L, Cerra F B
J Am Diet Assoc. 1987 Apr;87(4):441-8, 451.
Liver transplantation now provides a viable alternative to patients with end-stage hepatic failure. Because of the damaging effects of liver failure on other organ systems, transplant candidates frequently suffer from moderate to severe malnutrition. Chronic hepatic failure can result in deranged metabolism of not only macronutrients and micronutrients but also various hormones. Patients are frequently in a catabolic state. Wasting of the skeletal muscle mass occurs and synthesis of secretory proteins and clotting factors decreases. Hepatic encephalopathy and fluid/electrolyte imbalances often complicate the provision of appropriate nutrition support. Nutrition support may be provided by the oral route, tube feeding, parenteral nutrition, or a combination of those routes. A multidisciplinary approach to determine the appropriate nutrition support regimen is most optimal. To assess the efficacy of the support, monitoring of the nutritional/metabolic status is necessary on an ongoing basis. An aggressive nutrition support regimen can induce positive nitrogen balance, promote hepatic protein synthesis, and expand lean body mass, controlling the symptoms of malnutrition in end-stage liver disease.
肝移植现在为终末期肝衰竭患者提供了一种可行的替代治疗方法。由于肝衰竭对其他器官系统的损害作用，肝移植候选者常常患有中度至重度营养不良。慢性肝衰竭不仅会导致大量营养素和微量营养素代谢紊乱，还会导致各种激素代谢紊乱。患者常常处于分解代谢状态。骨骼肌质量会出现消耗，分泌蛋白和凝血因子的合成会减少。肝性脑病以及液体/电解质失衡常常会使提供适当的营养支持变得复杂。营养支持可通过口服途径、管饲、肠外营养或这些途径的组合来提供。采用多学科方法来确定合适的营养支持方案是最为理想的。为了评估支持治疗的效果，必须持续监测营养/代谢状况。积极的营养支持方案可以诱导正氮平衡，促进肝脏蛋白质合成，并增加瘦体重，从而控制终末期肝病的营养不良症状。
