肝硬化及慢性肝病患者之營養評估與治療策略

10.6666/ClinMed.202105_87(5).0053

郭鈞育；李沛璋；侯明志

肝硬化（liver cirrhosis） ； 營養不良（malnutrition） ； 肌少症（sarcopenia） ； 營養介入（nutrition intervention）

臨床醫學月刊

87卷5期（2021 / 05 / 28）

310 - 320

繁體中文

營養不良是肝硬化患者普遍存在的問題，並且與患者的預後息息相關；其中，肌少症是肝硬化患者營養不良最重要的核心問題。肝硬化患者由於其脂肪、肌肉組織的比例產生變化、加諸體液滯留（腹水形成）等問題，使得多數傳統的營養評估方式會產生誤差；而在營養介入方面，肝硬化患者也需要與一般患者不同的策略以進行更好的治療。對於肝硬化病患的初步營養篩檢，我們可以使用校正後的身體質量指數（adjusted body mass index, BMI）、Child-Pugh分數及Royal Free醫院營養評估指標（Royal Free Hospital-nutritional prioritizing tool, RFH-NPT）等工具。而針對營養不良中、高風險的患者需要更審慎地評估，例如；使用詳細飲食內容紀錄、身體組成及整體評估（global assessment）等工具。在確定病人患有營養不良後，臨床醫師應與營養師團隊合作，共同給予病患適當的營養支持介入，包括：飲食調整、營養補充和搭配適度的運動，以增進病人的預後。

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