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Early diet intervention to reduce the incidence of hepatic encephalopathy in cirrhosis patients: post-Transjugular Intrahepatic Portosystemic Shunt (TIPS) findings

早期饮食干预可降低肝硬化患者经颈静脉肝内门体分流术(TPIS)术后肝性脑病的发病率

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摘要


背景与目的:肝性脑病是肝硬化患者经颈静脉肝内门体分流术(TIPS)术后常见的并发症。本研究目的是通过积极的饮食干预降低TIPS 术后肝性脑病的发病率。方法与研究设计:选择2011年8月至2013年2月的99例接受TIPS术治疗的肝硬化患者作为对照组。其中,术后28例并发肝性脑病。采用回顾性研究分析肝性脑病发生的可能原因和诱因,饮食不当为主要诱因,占85.7%。2013年5月至2014年9月的83例肝硬化TIPS术后患者作为实验组,针对饮食不当这一主要问题采取相应的干预措施:制定TIPS术后护理常规,培训护士关于营养和常见食物中蛋白质含量的知识,定制低蛋白膳食,培训护士沟通技巧以提高对患者的营养知识教育,帮助建立家庭-社会支持系统。结果:实验组中有10例发生肝性脑病,发病率为12.1%,与对照组(28.3%)相比发病率显著降低(p<0.01)。结论:早期积极的饮食干预能显著提高肝硬化患者TIPS术后低蛋白饮食的依从性,降低肝性脑病的发生率。

並列摘要


Background and Objectives: Hepatic encephalopathy is a common complication in patients who have received transjugular intrahepatic portosystemic shunt (TIPS) as treatment for cirrhosis. The objective of this study was to reduce the incidence of post-TIPS hepatic encephalopathy for these patients via positive diet intervention. Methods and Study Design: As a control group, 99 cirrhosis patients who underwent TIPS treatment in our department between August 2011 and February 2013 were chosen. Among these, postoperative hepatic encephalopathy occurred in 28 cases. After analyzing the possible causes and incentives of hepatic encephalopathy by applying retrospective analysis, it was seen that hepatic encephalopathy was caused mostly by improper diet (85.7%). The experimental group was comprised of 83 cirrhosis patients who underwent TIPS treatment during the period from May 2013 to September 2014. In view of the influence of improper diet, appropriate intervention measures were taken, including developing a postoperative nursing routine, training nurses about nutrition and the protein content of kinds of various common foods, customizing low-protein meals, training nurses in communication skills to improve the education of patients and establishing family support systems. Results: For the experimental group, hepatic encephalopathy occurred in 10 patients, for an incidence of 12.1%, which is significantly lower than the control group (28.3%). This is a statistically significant difference (p<0.01) in the occurrence of this complication. Conclusions: After TIPS, early positive dietary intervention can significantly improve the compliance of cirrhosis patients to consume a low-protein diet and reduce the incidence of hepatic encephalopathy.

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