膽道閉鎖兒肝移植前後營養狀況之評估
營養不良會增加慢性肝病患者移植前的罹病率、死亡率及移植後感染機率、
住院天數甚至死亡率等問題，因此肝移植前營養狀況的評估是相當重要的。
因此本研究之目的為探討國內膽道閉鎖病童肝移植前後的營養狀況，以作為 日後營養照顧之參考。自臺大醫院收集 30 位膽道閉鎖患者，平均年齡介於 6 個月 -9 歲間，移植前測量身長及體重，並做飲食評估及計算每日平均熱量及 蛋白質的攝取量，並測量在移植前及移植後的骨密度。結果發現移植前身長 小於 25th% 者有 23 位 ( 佔 77%) ， 50th% 以上者僅有 1 位 ( 佔 3%) 。體重小 於小於 25th% 者有 25 位 ( 佔 83%) 沒有大於 50th% 者。蛋白質平均攝取量與 國人每日蛋白質的建議攝取量比較之下，是沒有顯著差異 (p=0.402) ，而熱量 的平均攝取量顯著低於國人每日熱量建議攝取量 (p<0.0001) 。骨礦物質密度 (bone mineral density) 在移植後一年較移植前有明顯增加 (p<0.0001) 。由實驗 結果發現，小兒膽道閉鎖患者移植前有嚴重的營養攝取不足，特別是熱量的 攝取，同時也有骨質量減少及生長遲緩等問題，但骨質量減少的情形在移植 後一年可獲得明顯改善。建議移植前對於食慾不振患者考慮早期給予管灌餵 食，以增加營養素的攝取，另外在移植後長期性的營養照顧上仍需要作進一 步的追蹤。
關鍵字：膽道閉鎖、骨礦物質密度、肝移植、營養狀況
Severe malnutrition before transplantation is associated with a higher rate of morbi dity, motality and a higher incidence of posttransplantation infections, surgical com plication. Assessment the nutritional status of patients with chronic liver disease is i mportment. Methods ： Nutrition assessment such as anthropometric, dietary recor d and bone mineral density in 30 patients of biliary atresia with end-stage liver dise ase. Results: twenty-three patients (77%) were below the 25th percentile for body h eight. twenty-five patients (83%) were below the 25th percentile for body weight. P rotein intake compare with DRI (Daily recommendation intake) were no difference (p=0.402). Energy intake compare with DRI were below and have significant (p<0.
0001). In conculsin, Sever malnutrition (especially energy intake) deacrease of bon e mineral density and failure to thrive in biliary atresia before the transplantation. H owever, the status of bone mineral density could be improved obviously in the first year of transplantation. Tube feeding should be given as earlier as possible to the p oor appetite patient before transplantation to increase nutrients intake. Also, long-te rm nutrition care for post-transplantation still need more follow-up.
Key word: biliary atresia, nutritional status, liver transplantation
