台灣小腸移植病患術後的營養照護經驗分享

The Experience Share with Nutritional Care of Post Operative Intestinal Transplantation Patients in Taiwan

孫文蕙(Wen-Huei Sun) ； 劉麗娟(Lie-Chuan Liu) ； 姜貴明(Guey-Ming Jing) ； 陳芸(Yun Chen)

《臺灣營養學會雜誌》 40卷3期 (2015/09) Pp. 87-93

https://doi.org/10.6691/NSJ.201509_40(3).0001

摘要

以往對短腸症或是小腸衰竭的患者提供居家全靜脈營養提升生存機會，但長期的全靜脈營養卻易發生肝功能異常等併發症，甚至因導管戚染引發敗血症，因此針對全靜脈營養發生重大併發症及符合小腸移植適應症者可提供小腸移植的選擇。目前文獻上雖有對小腸移植術後營養照護經驗報告，但並無台灣本土照顧紀錄探討，故本研究將以亞東醫院所進行的小腸移植個案做術後營養照護的經驗分享;過程中發現個案們發生短腸症或小腸衰竭的原因、年齡均不同，且術式、營養狀況具個別差異性，皆會影響在由口進食時對食物的選擇及接受度，進而影響營養攝取量。目前本院術後24小時內開始給予靜脈營養，於術後第3天進展至全靜脈營養，再視狀況進至腸道營養進而至由口進食；另外，要注意移植後腸道營養吸收情況於早期仍會變動，也需考量因淋巴管未重建會影響脂肪吸收，如何讓個案於小腸移植後能攝取適當營養，是照護此類個案最大的挑戰。

關鍵字

小腸移植 ； 靜脈營養 ； 腸道營養 ； 短腸症

並列摘要

In the past, patients with short bowel syndrome or intestinal failure were provided home-based total parenteral nutrition (TPN) to enhance survival rates, but long-term TPN might cause many complications such as abnormal liver function and catheter infection, and even induce sepsis. Therefore, if this kind of patient conformed to the indication of intestinal transplantation, then it was provided. Nowadays, although there are some literatures shared nutritional care experiences of small intestine transplantation, there are no reports from Taiwan. So, this study share postoperative nutritional care experience of intestinal transplantation patients at the Far Eastern Memorial Hospital, Taipei. We investigated postoperative nutritional care process, including the progression from parental nutrition to enteral nutrition and oral intake, and discussed nutritional problems of each case. We found that age and the etiology of intestinal failure for each case different, and operative procedures and nutritional status also exhibited individual differences. All of these factors influenced the choice of food intake and the acceptable degree of food, thus affecting nutrition intake. In our hospital, we supply parental nutrition within 24 h postoperatively, and progress to TPN on the third day postoperatively. Then, we observe the condition of the patients, and supply enteral nutrition and oral intake. Moreover, the nutrient absorption rate may change in the early stage postoperatively, in addition, one needs to be concerned about how lymphatic duct reconstruction can affect fat absorption. Determining how to implement individualized appropriative nutrition strategies for postoperative patients is a big challenge for the entire medical team.

並列關鍵字

short bowel syndrome ； intestinal failure ； intestinal transplantation ； parenteral nutrition ； enteral nutrition