特集名 | 合併症を伴う透析患者の栄養指導 | |
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題名 | 肝・胆・膵疾患 | |
発刊年月 | 1998年 12月 | |
著者 | 中村 享道 | 山梨医科大学輸血部 |
著者 | 寺本 房子 | 川崎医療福祉大学臨床栄養学科 |
【 要旨 】 | 肝・胆・膵疾患を合併した透析患者の栄養指導について述べた.急性肝炎の急性期には,摂取できるものを優先し,不足したエネルギーは経静脈的に補給する.食欲が回復したら,経口的に栄養補給を行う.慢性肝炎,肝硬変の代償期には,透析食を基本としてバランスのとれた食事を規則的に行うよう指導する.非代償期で高アンモニア血症や肝性脳症がある場合には,食事からのたんぱく質制限を開始する.不足するたんぱく質は分枝鎖アミノ酸製剤で補う.脂肪の極端な制限は好ましくなく,多価不飽和脂肪酸含量の多い植物性脂肪や魚油の摂取を指導する.腹水がある場合,食塩を5g/day以下に制限する. 胆石症では,急性期には絶食,経静脈栄養とし,無症状期には動物性脂肪の制限と規則正しい食事習慣を指導する. 急性膵炎では,急性期には絶食,経静脈栄養とし,回復期には脂質制限と脂溶性ビタミンの補充を行う.慢性膵炎では,代償期には脂質,非代償期には脂質とエネルギーの制限を行い,たんぱく質は透析食に準じる. |
Theme | Nutritional Guidance for Hemodialysis Patients with Complications | |
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Title | The diseases of liver, biliary tract and pancreas | |
Author | Takamichi Nakamura | Division of Blood Transfusion, Yamanashi Medical College |
Author | Fusako Teramoto | Department of Clinical Nutrition, Kawasaki University of Medical Welfare |
[ Summary ] | Nutritional treatment for hemodialysis patients with diseases of the liver, biliary tract or pancreas is discussed. Patients with acute phase hepatitis should receive necessary intravenous supplementation of the correct caloric values. For patients with compensatory phase chronic hepatitis or cirrhosis, instruction should be given concerning nutritionally balanced meals designed for their conditions. Protein restriction is indicated for non-compensatory phase cirrhosis patients with hyperammonemia or hepatic encephalopathy. Branched-chain amino acid preparations should be used to compensate for protein shortages. Patients should be instructed to consume vegetable fats or fish oil, which contains abundant quantities of polyatomic unsaturated fatty acids. They should be instructed to do so rather than excessively restricting all fat intake. If the patient has ascites, sodium intake should be restricted to not more than 5g/day. Patients with acute phase cholelithiasis should fast along with intravenous alimentation. At the asymptomatic phase restricted consumption of animal fats along with regular meals should be advised. Acute phase pancreatitis patients should continue to fast as well as receive intravenous alimentation. In the recovery phase, restriction of fat intake and supplimentation of lipid-solible vitamins should be recommended. For patients with chronic pancreatitis, restriction of fat intake should be recommended in the compensatory phase. In the non-compensatory phase, restriction of fat and general caloric intake, including protein, should be advised for the dietary program of these dialysis patients. |