熊墨龙　王小花　欧阳兵

[摘要] 目的 探讨重型肝炎患者个体化营养支持治疗的临床效果。 方法 60例被临床确诊为重症肝炎患者入院后对其营养状况采用综合性评价，数字抽签随机分为治疗组和对照组各30例，治疗组在常规肝病综合治疗的基础上实施个体化营养支持治疗，营养支持治疗方法依据患者个体化差异采用肠内、肠外二者相结合方式。对照组给予常规肝病综合治疗，不给予针对性营养支持治疗。检测患者营养支持治疗前、后各项生化指标的变化及出现并发症的情况。 结果 治疗前两组患者均存在不同程度营养不良，治疗后所有患者营养状况均不同程度改善，重型肝炎患者在营养支持治疗4周后，生化指标（ALT、TBIL、ALB、GLU）顯著改善（P<0.01），与对照组比较，治疗组改善患者肝功能效果更加显著。 结论 营养支持治疗重症肝炎有效，营养支持过程中应遵循个体化差异，依据患者自身病情及疾病发展过程制订合理恰当的营养支持计划，配合肝病综合治疗方法可取得满意疗效。

[关键词] 重症肝炎；个体化； 营养治疗；生化指标

[中图分类号] R575.1 [文献标识码] B [文章编号] 1673-9701（2017）16-0084-03

[Abstract] Objective To investigate the clinical effect of individualized nutritional support treatment of severe hepatitis patients. Methods 60 patients with severe hepatitis underwent comprehensive evaluation of nutritional status after admission. These patients were randomly divided into a treatment group and a control group according to digital draws，with 30 cases in each group. The treatment group received individualized nutritional support treatment on the basis of comprehensive treatment of liver diseases. Enteral or parenteral nutrition were adopted according to individual differences of patients. The control group received the conventional comprehensive treatment of liver diseases without individualized nutritional support treatment. The change of biochemical indices before and after the nutritional support treatment and the occurrence of complications were recorded. Results The nutritional status of two groups who all were malnourished on admission improved in different levels after the treatment. The biochemical indices（ALT， TBIL， ALB， GLU） of patients who underwent nutritional support treatment for 4 weeks were significantly improvement（P<0.01）. Compared with the control group the liver function in the treatment group improved more obviously. Conclusion Nutritional support treatment in severe hepatitis is effective. During the nutritional support treatment， physicians should follow individual differences， which means making appropriate plans according to patients condition and the development process of diseases， and coordinate the nutritional support treatment with the comprehensive treatment of liver diseases so as to attain satisfactory effect.

[Key words] Severe hepatitis；Individualized；Nutritional support treatment；Biochemical indexes

我国是肝炎高发地区，每年死于肝炎相关疾病者约30万，其中部分是由重型肝炎/肝衰竭导致的[1]。重型肝炎/肝衰竭患者存在营养不良及营养供给不足的现象较普遍，特别是蛋白质-热能营养不良[2，3]。营养治疗是治疗重型肝炎/肝衰竭非常重要的环节，通过合理安排饮食，使患者科学、合理控制能量，合理摄入糖类、蛋白质、脂肪等，补充疾病时相对缺少的营养素[4]。患者的合理营养与治疗效果关系密切，向患者提供合理的饮食和营养，对促进肝细胞的修复、改善肝功能、缓解临床症状、提高药物疗效和缩短病程均具有积极意义[5]。

本研……