Ibrahim Eman S, Houseni Mohamed
Department of Anaesthesia and ICU, Liver Institute, Menoufia University, Shebeen Elkom, Egypt.
Department of Radiology, Liver Institute, Menoufia University, Shebeen Elkom, Egypt.
Saudi J Anaesth. 2021 Apr-Jun;15(2):116-122. doi: 10.4103/sja.SJA_923_20. Epub 2021 Apr 1.
We evaluated the effects of postoperative administration of (ONSs) on the liver function and the outcome of cirrhotic patients using ultrasound (US) assessment of rectus femoris (RF) and anterior tibialis (AT) muscles.
Forty-three malnourished adult hepatic patients who underwent major liver resections were recruited in this study. In the conventional diet (CD) group, the patients took water at postoperative day (POD) 0 and routine soft diet starting from POD1. In the ONS group, a commercially elemental diet was started from POD1 for 7 days postoperatively, with a target endpoint of 35-40 kcal/kg and 1.2-1.5 g/kg of protein per day. US assessment of the RF and AT muscles was done preoperatively and at POD3 and 7, including anterior-posterior (AP) diameter, lateral-lateral (LL) diameter, and cross-sectional area (CSA). Muscles' echogenicity was defined by the Heckmatt scale. The outcome of the patients was also recorded.
Consumption of ONS preserved the measured RF and AT characteristics (AP and LL diameters and CSA) in the ONS group at POD3 and 7 compared to the CD group. Heckmatt scale was significantly increased at POD3 and 7 in the CD group compared to the ONS group. Both total protein and albumin levels at POD3 and 7 were significantly lower in the CD group compared to the ONS group [P = (0.02, 0.03) and (0.05, 0.04), respectively]. Serum phosphate was significantly lower at POD7 in the ONS group than the CD group (p = 0.04). There were significant decreases in the ICU stay and time of passing flatus (h) in the ONS group comparing with the CD group ( = 0.045 and = 0.00, respectively).
ONS maintains muscle mass and echogenicity of RF and AT along with better liver function and intestinal function recovery.
我们通过超声（US）评估股直肌（RF）和胫前肌（AT），来评估术后给予口服营养补充剂（ONSs）对肝硬化患者肝功能及预后的影响。
本研究纳入了43例接受大肝切除术的营养不良成年肝病患者。常规饮食（CD）组患者在术后第0天（POD 0）饮水，并从POD 1开始进食常规软食。ONS组从POD 1开始给予市售要素饮食，持续术后7天，目标终点为每天35 - 40千卡/千克和1.2 - 1.5克/千克蛋白质。术前以及POD 3和7时对RF和AT肌肉进行超声评估，包括前后径（AP）、左右径（LL）和横截面积（CSA）。肌肉回声强度由Heckmatt量表定义。同时记录患者的预后情况。
与CD组相比，ONS组在POD 3和7时，口服营养补充剂使测得的RF和AT特征（AP和LL直径以及CSA）得以保留。与ONS组相比，CD组在POD 3和7时Heckmatt量表显著升高。与ONS组相比，CD组在POD 3和7时的总蛋白和白蛋白水平均显著降低[P值分别为（0.02，0.03）和（0.05，0.04）]。ONS组在POD 7时的血清磷酸盐水平显著低于CD组（p = 0.04）。与CD组相比，ONS组的重症监护病房（ICU）住院时间和排气时间（小时）显著缩短（分别为 = 0.045和 = 0.00）。
ONS可维持RF和AT的肌肉质量和回声强度，同时促进肝功能和肠道功能更好地恢复。
