疾病营养治疗指导方案：肝胆胰疾病营养治疗肝硬化

肝胆胰疾病营养治疗肝硬化

Liver disease may advance to the chronic state of ci rrhosis. The mos t comm on prob I em i s fatty c i rrhos i s assoc i a ted with ma I nu trit ion and a I coho Ii sm. The re Ient I ess ma Inutrition Ieads to multiple nutritionaI deficiencies as dr inking alcohol increasingly substitutes for eating meaIs. Alcohol and it metaboIic products can a I so cause d i rect damage to liver cells・The accompanying fatty i nf i I trat i on kills I i ver cells, and on I y n onf unc t i on i ng f i brous scar tissue remains. Eventually, low plasma protein I eve Is fa I I, caus i ng ascites. Scar tissue impa i rs bIood ci rcuI ation, resuIting i n eIevated venous bIood pressure and esophageaI var ices. Often the rupture of these enlarged veins with massive hemorrhage is the cause of death. When a I coho Ii sm i s the underIy ing prob Iem, treatment is difficu11. Nutritional therapy focuses on as much heaIing support as possible・

1.Protein according to toleranee. In the absenee of impending hepatic coma, the diet shouId suppIy approximately 80 to 100g of pro tein a day to correc t the severe ma I nu trit ion, hea I I i ver t issue, and res tore p I asma pro teins. I f s ig ns of coma beg in, the pro tein mus t be reduced to individual toleranee.

2.L ow sodium. Sodiurn is restrieted to about 500 to 1000 mg a day to he Ip reduce the fluid retention.

3.Soft texture. I f esophageaI var ices develop, soft foods he Ip

prevent the danger of rupture and hemorrhage.

4.Optima I genera I nutr i t ion. The remai ning d iet pr inciples outlined for hepatitis are continued for ci rrhosis for the same reasons. Calor ies, carbohydrates, and vitamins, especiaI Iy B-compI ex vitamins such as th i am in and folic acid, are important. Moderate fat is used. AI coho I i s forb i dden.

一、概述

肝硬化(hepatic cirrhosis)是一种临床常见的由多种病因引起的慢性、进行性肝脏损害，是各种慢性肝脏疾病的晚期表现。本病的流行病学特点为男性多于女性，35〜50岁为多见。

(一)病因

引起肝硬化的病因很多，各地区差异较大。①病毒性肝炎：主要为乙型、丙型和丁型肝炎病毒感染，尤其是乙型与丙型或丁型肝炎病毒重叠感染时可加速肝硬化的发生；②慢性酒精中毒：长期大量饮酒，酒精及其代谢产物引起肝脏损害，引发酒精性肝炎、酒精性脂肪肝，继而发展为肝硬化；③营养障碍：营养过剩与营养不良均可导致非酒精性脂肪肝(NASH), 据统计约70%不明原因肝硬化可能由NASH引起；④其他：胆汁淤积、肝静脉回流受阻、遗传代谢性疾病、某些药物或毒物、自身免疫等因素亦可导致肝硬化。在该病的众多病因中，我国以病毒性肝炎为主，欧美国家以慢性酒精中毒为多见。

（二）主要临床表现

起病隐匿，病程进展缓慢，早期症状轻、个体差异大并且无特异性，晚期临床表现明显，病人的生活质量明显下降。临床上根据肝功能受损的程度将其分为代偿期与失代偿期肝硬化两种。

1.代偿期肝硬化常见乏力、食欲下降，轻度腹胀、恶心、呕吐等。

2.失代偿期肝硬化以肝功能减退、门脉高压、腹水为主要表现，并常伴有多种并发症。①全身症状：消瘦、乏力，少数患者可见不规则热；②消化道症状：食欲减退与腹胀为临床常见症状，还可见恶心、呕吐，由于对蛋白质和脂肪耐受性差，在进食高蛋白与油膩食品时易出现腹泻；③ 贫血与出血：因进食差，病人多伴有不同程度贫血，由于肝功减退，肝脏合成凝血因子减少及脾功亢进导致血小板减少，常见齿龈出血、鼻出血、皮肤紫瘢以及月经过多等；④与内分泌紊乱有关的症状：男性可有性功能减退、乳房发育；女性可发生闭经、不孕；⑤门脉高压症状：表现为呕血与黑便，亦可伴有贫血及明显腹胀。

肝硬化往往呈现慢性肝病面容，面色黝黑、无光泽，晚期可见明显消瘦、肌肉萎缩、腹水等。皮肤可见黄疸、肝掌、蜘蛛痣。此外，部分患者可出现下肢浮肿及肝性胸水二、营养代谢特点

肝脏与机体的物质代谢、胆汁生成、凝血因子合成以及免疫机能维持密切相关。肝硬化时，由于肝脏功能受损，机体可出现一系列代谢紊乱，严重者会涉及全身各个系统，甚至危及生命。

（一）蛋白质代谢