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《2020年欧洲临床营养和代谢学会实践指南:肝病的临床营养》解读

贾丹丹 朱桂英 廖诗瑶 章慧 郭慧 杨莉莉 王长淼

贾丹丹,朱桂英,廖诗瑶,等. 《2020年欧洲临床营养和代谢学会实践指南:肝病的临床营养》解读[J]. 临床肝胆病杂志, 2021, 37(7): 1553-1557. DOI: 10.3969/j.issn.1001-5256.2021.07.015
引用本文: 贾丹丹,朱桂英,廖诗瑶,等. 《2020年欧洲临床营养和代谢学会实践指南:肝病的临床营养》解读[J]. 临床肝胆病杂志, 2021, 37(7): 1553-1557. DOI: 10.3969/j.issn.1001-5256.2021.07.015
JIA DD, ZHU GY, LIAO SY, et al. Interpretation of European Society for Clinical Nutrition and Metabolism practical guideline: Clinical nutrition in liver disease (2020)[J]. J Clin Hepatol, 2021, 37(7): 1553-1557. DOI: 10.3969/j.issn.1001-5256.2021.07.015
Citation: JIA DD, ZHU GY, LIAO SY, et al. Interpretation of European Society for Clinical Nutrition and Metabolism practical guideline: Clinical nutrition in liver disease (2020)[J]. J Clin Hepatol, 2021, 37(7): 1553-1557. DOI: 10.3969/j.issn.1001-5256.2021.07.015

《2020年欧洲临床营养和代谢学会实践指南:肝病的临床营养》解读

DOI: 10.3969/j.issn.1001-5256.2021.07.015
基金项目: 

国家自然科学基金 81774082

详细信息
    通讯作者:

    王长淼,wangchangmiaodl@sohu.com

  • 中图分类号: R575

Interpretation of European Society for Clinical Nutrition and Metabolism practical guideline : Clinical nutrition in liver disease (2020)

Funds: 

National Natural Science Foundation of China 81774082

  • 摘要: 2020年12月,欧洲临床营养和代谢学会(ESPEN)发布了最新的肝病临床营养实践指南,该指南基于已发表的ESPEN肝病临床营养指南及最新临床证据,对急性肝衰竭、酒精和非酒精性脂肪性肝炎、肝硬化、肝移植患者的营养和代谢管理提出103条陈述和建议,全面概括了临床营养诊治原则和诊疗措施,提供了较为全面的营养方案指导。

     

  • 表  1  ALF营养方案

    项目 推荐意见 等级
    口服 仅轻度HE且咳嗽、吞咽反射完好的ALF患者首选口服 GPP级,强烈共识100%
    伴轻度HE的ALF患者口服营养不能达到喂养目标的,应使用口服ONS GPP级,共识85%
    EN 无营养不良的ALF患者若被认为不太可能在未来5~7 d内恢复正常的口服营养,应像其他重病患者一样使用EN GPP级,强烈共识96%
    PN 营养不良的ALF患者应像其他重病患者一样,立即开始EN和/或PN GPP级,强烈共识96%
    不能口服和/或EN无法满足营养需求ALF患者,开始PN治疗(PN为二线治疗) GPP级,共识90%
    下载: 导出CSV

    表  2  ASH营养方案

    项目 推荐意见 等级
    口服 咳嗽和吞咽反射完好的严重ASH者,首选口服 GPP级,强烈共识100%
    患有严重ASH的患者无法通过正常食物满足热量需求时,应选ONS B级,强烈共识100%
    严重ASH的患者无法通过正常食物满足热量需求时,应将ONS作为傍晚或夜间补剂使用(ONS为一线治疗) GPP级,强烈共识100%
    EN 严重ASH的患者无法通过正常食物和/或ONS满足热量需求时,应使用EN B级,强烈共识100%
    PN 严重ASH的患者禁食期持续超过72 h时,应开始全PN支持 GPP级,强烈共识100%
    伴有中重度营养不良ASH患者,无法通过口服和/或肠内途径补充营养的患者,应立即开始PN GPP级,强烈共识100%
    在气道未受保护和HE患者中,当咳嗽和吞咽反射受损或EN是禁忌或不可行时,应考虑使用PN GPP级,多数同意72%
    对于严重ASH患者应像其他重症患者给予PN GPP级,强烈共识100%
    下载: 导出CSV

    表  3  NAFL/NASH营养方案

    项目 推荐意见 等级
    口服 伴有乳糜泻的NAFL/NASH的患者应遵循无麸质饮食 B级,强烈共识96%
    无糖尿病的NASH成人患者给予维生素E(α-生育酚800 IU/d) B级,强烈共识100%
    不建议使用抗氧化剂(例如维生素C、白藜芦醇、花青素等)、ω-3脂肪酸 0级,强烈共识100%
    包含选定的益生菌或合生元的营养补品可用于改善NAFL/NASH患者的肝酶 0级,共识89%
    EN/PN 伴有严重并发症的NAFL/NASH、口服无法满足或禁忌不可行时,应给予EN或PN GPP级,强烈共识96%
    BMI<30 kg/m2的NAFL/NASH患者,应按照ASH患者的建议进行EN和/或PN GPP级,强烈共识100%
    伴有并发疾病的肥胖NAFL/NASH患者应给予EN和/或PN,目标能量摄入量为25 kcal·kg-1IBW·d-1,目标蛋白摄入量增加为2.0~2.5 g·kg-1IBW·d-1 GPP级,多数同意71%
    下载: 导出CSV

    表  4  肝移植术前阶段营养管理建议

    术前 推荐意见 等级
    对计划进行择期手术或列 应筛查评估营养不良状况 B级,强烈共识100%
    为移植的肝硬化患者 按照肝硬化的建议进行营养管理 GPP级,强烈共识100%
    建议摄入量:总能量30~35 kcal·kg-1·d-1(126~147 kJ·kg-1·d-1)和蛋白质摄入1.2~1.5 g·kg-1·d-1 GPP级,强烈共识100%
    安排手术后 应根据ERAS方法对进行治疗管理 GPP级,强烈共识100%
    肥胖患者 给予EN和/或PN,目标能量摄入量为25 kcal·kg-1IBW·d-1,目标蛋白摄入量为2.0~2.5 g·kg-1IBW·d-1 GPP级,强烈共识93%
    计划进行择期手术的超重/肥胖NASH患者 应按照NASH的建议进行治疗 GPP级,强烈共识100%
    等待移植的成人 应采用标准的营养方案 A级,强烈共识100%
    等待移植的儿童 应使用富含BCAA的营养配方 B级,强烈共识93%
    捐献者 不建议使用特定的营养方案 GPP级,强烈共识100%
    下载: 导出CSV
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