熊墨龙　王小花　欧阳兵

[摘要] 目的 探討重型肝炎患者个体化营养支持治疗后的营养状况变化。 方法 60例被临床确诊为重型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，治疗前两组之间营养状况无显著差异，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。治疗前后所有患者均用SGA营养评价表评价营养状况并测量患者的静息能量代谢、体重、体质指数。 结果 治疗前60例均存在不同程度营养不良，在营养支持治疗4周后，治疗组共23例转为营养良好（A 级），营养状况显著改善；对照组共4例转为营养良好（A 级），营养状况好转不明显；治疗组静息能量代谢、体重、体重指数明显改善（P<0.05），与对照组比较，营养状况的改善更明显。 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，且无相关不良反应，安全性良好。

[关键词] 重症肝炎；个体化；营养治疗；营养状况指标

[中图分类号] R575.1 [文献标识码] B [文章编号] 1673-9701（2017）19-0076-03

[Abstract] Objective To study the change of nutritional status in individualized nutritional support treatment of severe hepatitis patients. Methods A total of 60 patients with severe hepatitis underwent comprehensive evaluation of nutritional status after admission. These patients were randomly divided into treatment group and control group by digital draws （30 cases in each group）. There was no significant difference in nutritional status between two groups. 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. All patients underwent nutritional evaluation according to the SGA（Subjective Global Assessment of Nutrition） form before and after the nutritional support treatment， and resting energy expenditure， weight， BMI were recorded. Result All of the 60 patients were malnourished on admission. After 4 weeks of treatment， 23 cases turned into good nutrition （A grade） in the treatment group， which showed a significant improvement in nutritional status. 4 cases turned into good nutrition（A grade） in the control group， which didn't show significant improvement in nutritional status. The resting energy expenditure， weight and BMI of patients were significant improvedin the treatment group （P<0.05）. Compared with the control group， the nutritional status improved more prominent. 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. Besides the nutritional support treatment has no related adverse effect， the safety is confirmed.

[Key words] Severe hepatitis； Individualized； Nutritional support treatment； Nutritional status

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[1-2]。营养治疗是治疗重型肝炎/肝衰竭非常重要的环节，营养治疗的目的是通过合理安排饮食，使患者科学、合理控制能量，合理摄入碳水化合物、蛋白质、脂肪等，补充疾病时相对缺少的营养素[3-4]。合理的营养治疗可以改善肝脏的营养状态，调节免疫功能，保护肝细胞，并增强肝细胞的修复再生能力[5]，纠正各种营养素的代谢失衡[6]。……