肝性脑病教程教学稿件.pptVIP

Treatment Provision of Supportive Care Adequate supportive care is critical during all stages of HE and may involve other professionals in the provision of patient care. TREATMENT GOALS Identification and Removal of Precipitating Factors A vigorous search to identify and eliminate a precipitating factor or factors should be immediately instituted. Reduction of Nitrogenous Load From the Gut Measures to reduce the nitrogenous load from the gut should be implemented. Assessment of the Need for Long Term Therapy Patients with cirrhosis are at risk of developing new episodes of encephalopathy . At discharge, three factors need to be considered: Control of potential precipitating factors Higher likelihood of recurrent encephalopathy Assessment of the need for liver transplantation TREATMENT OPTIONS --Treatment of HE is based on several, non–mutually exclusive options. Patients with HE should avoid prolonged periods of dietary protein restriction and receive the maximum tolerable protein intake, aiming at 1.2 g of protein/kg/day (range 1–1.5). Acute encephalopathy. Protein feeding can be withdrawn for the first day. Short term (4 days) enteral nutrition has not been shown to benefit hospitalized cirrhotic patients Nutritional Management Chronic management. An increase in protein tolerance can be achieved by increasing protein intake in combination with other therapeutic measures Hepatic Encephalopathy肝性脑病 男性，56岁。因“发现HBsAg阳性25年，反复乏力、纳差、腹胀3年，加重伴神志淡漠2天”入院。 患者25年前起，体检时发现“乙肝两对半：HBsAg(+)，HBeAg(+)，HBcAg(+)”，当时肝功能正常，患者无不适，未作进一步诊治。3年前起，无明显诱因反复出现乏力、纳差、腹胀等不适，在外院以“乙肝肝硬化失代偿期”给予诊治（具体不详），病情一度好转后患者自行停药，病情反复，患者自服中成药治疗。3天前起，因酗酒并进食大量蛋白质后，患者出现腹胀加剧，伴有睡眠日夜颠倒，神志淡漠，无昏迷，为作进一步的诊治收入我院。起病以来，无呕血或排黑便，无身目黄染，无皮肤黏膜出血，无肝区疼痛不适，无消瘦，两便正常。 什么是肝性脑病？（定义） 什么情况下应考虑肝性脑病的可能（临床表现） 怎样明确是肝性脑病（诊断和排除/鉴别诊断,肝性脑病的完整诊断思路） 如何治疗肝性脑病？ 肝性脑病的认识思路 Definition (1) Hepatic encephalopathy (HE) It represents a reversible decrease in neurologic function, based upon the disorder of metabolism which ar