Carda P, Sastre A, Laroche F, Morales V, Marcos J M
Infusionsther Klin Ernahr. 1985 Oct;12(5):251-3. doi: 10.1159/000221747.
We report on 22 cirrhotic patients suffering from portal hypertension and bleeding esophageal varices. Sixteen of them underwent H mesocaval shunt with internal jugular vein graft and 6 spleno-renal shunts. Mortality was 13.2%. All the patients were treated postoperatively with parenteral and oral nutritional support with solutions containing no aromatic amino-acids, following Fischer's formula. We determined Fischer's index (formula; see text); normal value 2.67 +/- 0.22) on the day of operation (1.6 +/- 0.22), on the 8th postoperative day (2.32 +/- 0.49), and on the 15th postoperative day (1.85 +/- 0.37). Only 1 patient suffered from hepatic encephalopathy in the immediate postoperative period. Three months after operation Fischer's index was 1.20 +/- 0.11 and only 2 patients with an index below 1 suffered from chronic encephalopathy. We conclude that there is a correlation between Fischer's index and the presence of post-shunt hepatic encephalopathy. The proposed policy of parenteral nutrition improves the values of Fischer's index in the immediate postoperative period and we believe that nutritional support should be included routinely as an adjuvant therapy in portosystemic shunts in cirrhotic patients.
我们报告了22例患有门静脉高压症和食管静脉曲张出血的肝硬化患者。其中16例行经颈内静脉移植的H型门腔分流术，6例行脾肾分流术。死亡率为13.2%。所有患者术后均按照费舍尔公式接受不含芳香族氨基酸溶液的肠外和肠内营养支持治疗。我们在手术当天（1.6±0.22）、术后第8天（2.32±0.49）和术后第15天（1.85±0.37）测定了费舍尔指数（公式；见正文）；正常值为2.67±0.22。术后即刻只有1例患者发生肝性脑病。术后3个月，费舍尔指数为1.20±0.11，指数低于1的患者中只有2例患有慢性脑病。我们得出结论，费舍尔指数与分流术后肝性脑病的发生之间存在相关性。建议的肠外营养策略在术后即刻改善了费舍尔指数的值，并且我们认为营养支持应作为肝硬化患者门体分流术的常规辅助治疗方法。
