目的 探讨肠内营养（EN）、肠内外联合营养（EN+PN）两种营养支持方式对急性肝衰竭患者临床疗效、营养状况的影响以及两者间安全性的差异。方法 收集2018年1月—2023年6月收治的诊断为急性肝衰竭,且住院治疗期间经EN营养支持或EN+PN营养支持患者的临床资料,共60例患者纳入研究,其中EN组30例,EN+PN组30例。对两组患者临床疗效（2周后临床症状体征好转率、4周生存率）、肝功能相关指标血清白蛋白（Alb）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、总胆红素（TBil）、凝血酶原时间（PT）、营养状况上臂围、体重指数、全球领导人营养不良倡议（GLIM）营养不良阳性诊断率）及营养支持相关并发症进行统计分析。结果 EN+PN组肝功能指标（ALT、AST、TBil、Alb）及上臂围、BMI 的改善效果均显著优于EN组,临床症状体征整体改善情况更优（P<0.05）,且两组营养支持相关并发症发生率差异无统计学意义（P>0.05）。结论 EN+PN组营养支持方式在改善急性肝衰竭患者营养状况、促进肝功能恢复以及提高生存率方面,优于EN营养支持组,且是一种安全有效的营养支持方式。
Objective To investigate the effects of enteral nutrition （EN） and combined enteral and parenteral nutrition （EN+PN） on clinical efficacy and nutritional status in patients with acute liver failure, as well as to compare the safety between the two nutritional support methods. Methods Clinical data of 60 patients diagnosed with acute liver failure who received EN or EN+PN nutritional support during hospitalization from January 2018 to June 2023 were collected. These patients were divided into two groups： the EN group （n=30） and the EN+PN group （n=30）. Statistical analysis was performed on the clinical efficacy （2-week improvement rate of clinical symptoms and signs, and 4-week survival）, liver function-related indicators serum albumin （Alb）, alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, total bilirubin （TBil）, and prothrombin time （PT）, nutritional status upper arm circumference, body mass index, and diagnosis rate of malnutrition based on the Global Leadership Initiative on Malnutrition （GLIM） criteria, and complications related to nutritional support in the two groups. Results The improvements in liver function indicators （ALT, AST, TBil, and Alb）, upper arm circumference, and BMI in the EN+PN group were significantly greater than those in the EN group, and the overall improvement in clinical symptoms and signs was also superior （P < 0.05）. Moreover, there was no statistically significant difference in the incidence of nutrition support‑related complications between the two groups （P > 0.05）. Conclusion The EN+PN nutritional support method is superior to the EN nutritional support method in improving the nutritional status, promoting liver function recovery, and increasing survival in patients with acute liver failure. It is also safe and effective.
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