Wen Sun Zhongxin (Department of Gastroenterology, General Hospital of Chengdu Military Region)
Cirrhosis is a chronic, diffuse, progressive liver disease caused by different etiologies. Cirrhosis is mostly progressive, irreversible, with a long course of treatment, many complications, and a poor prognosis. The cause of cirrhosis in China is mainly hepatitis B virus infection, and the proportion of cirrhosis caused by various causes such as alcohol, fat, drug and biliary origin has also increased year by year. Many complications such as gastrointestinal bleeding, ascites, hepatic encephalopathy, liver cancer and so on in the course of patients with cirrhosis can easily lead to negative emotions such as anxiety and depression in the treatment process, affecting the patient's physical and mental health and quality of life, thus affecting the prognosis of the disease. Paying close attention to the daily health care and health testing of patients with cirrhosis is essential to improve the quality of life of patients with cirrhosis.
Treatment of the cause
HBV infection is an important cause of cirrhosis in China, and all patients with hepatitis B virus surface antigen-positive cirrhosis should be treated with antiviral therapy, mainly using nucleoside (acid) drugs such as entecavir and tenofovir ester. By continuously inhibiting the virus, the progression of liver disease is delayed, especially the incidence of liver cancer may be reduced.
In the treatment of patients with alcoholic cirrhosis caused by long-term drinking, it is first necessary to quit alcohol and choose relevant drugs according to the specific situation of the patient. Drug-induced cirrhosis is not uncommon, such as the commonly used soil sanchi, He Shou Wu, Triptolide, etc., especially for susceptible people in the treatment process, try to avoid or do not use such drugs. Etiological treatment can effectively delay the progression of cirrhosis to a certain extent, reduce infection and other related complications, and ultimately improve the quality of life of patients.
Reasonable meals
Strict adherence to dietary requirements and ensuring nutritious dietary intake have a positive effect on improving liver function and delaying the deterioration of the disease, and the diet of patients with cirrhosis should be based on high-calorie, low-fat, high-protein and high-vitamin digestible foods. Sufficient calories can reduce the consumption of protein, reduce the burden on the liver, and facilitate the synthesis of tissue proteins.
Patients with cirrhosis are more suitable for daily food calories of 2500 to 2800 kcal. By weight, about 35 to 40 kcal per kilogram of body weight per day.
Be comprehensive and rich in vitamins. B vitamins have important physiological effects on promoting digestion, protecting the liver and preventing fatty liver. Vitamin C can promote metabolism and has detoxification function, fat-soluble vitamins A, D, E have different degrees of protective effect on the liver.
Appropriate amount of protein. It is generally supplied with 100 to 120 grams per day. When plasma protein is reduced, it is necessary to supplement a large amount of protein, which can provide 1.5 to 2 grams per kilogram of body weight per day, and those with ascites or glucocorticoid therapy can increase to 2 to 3 grams per kilogram of body weight per day. A higher-protein diet is important for protecting liver cells and repairing damaged liver cells. In principle, patients with severe hepatic impairment and concurrent hepatic encephalopathy should stop all protein intake, and protein intake should be gradually increased as the condition improves until the maximum clinical tolerance is limited. However, most patients with cirrhosis are malnourished, and restricting the protein diet for a long time can exacerbate malnutrition. And negative nitrogen balance will increase the mobilization of skeletal muscle, but increase the blood ammonia to aggravate hepatic encephalopathy. Therefore, in the issue of protein intake, it should be grasped: (1) the acute stage (gastrointestinal bleeding, liver coma) prohibits the protein diet, mainly glucose supply energy; (2) the protein intake in the chronic stage, especially with hepatic encephalopathy, is controlled at 1 to 1.5g /(kg.d), plants and dairy products are better than animal proteins, because the former contains more branched chain amino acids and can provide fiber to maintain normal flora and acidify the intestine.
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Good living habits
Clinically, it has been shown that patients with early cirrhosis can be controlled if they can be treated in time. However, we also know that the chance of cirrhosis turning into liver cancer is also relatively large, so in order to better treat cirrhosis and reduce the possibility of developing liver cancer, patients need to pay more attention in life and develop good living habits.
1, non-smoking alcohol: alcohol can make liver fat degeneration and carcinogenic, therefore, patients with cirrhosis should be drip alcohol, so as not to cause more serious liver damage; Tobacco contains a variety of harmful substances that can impair the recovery of liver function, so patients with cirrhosis must decide to quit smoking.
2, reasonable rest, avoid overwork: living should be regular, so that it is conducive to the recovery of health. You must get enough sleep every day and participate in the slight activities within your ability, but be careful not to be tired, and once the disease progresses, you must stay in bed and actively treat.
3. Avoid taking drugs indiscriminately: due to the reduction of liver function during cirrhosis, the detoxification process of drugs in the liver is greatly slowed down, and drugs can accumulate in the body, especially anesthetic sedatives not only have a direct toxic effect on the liver, but also induce liver coma. Therefore, to use as little medication as possible, the drugs used must be used only if they are not used.
Visit the hospital regularly for check-ups
When patients with cirrhosis of the liver are discharged from the hospital, they should follow the doctor's instructions to the hospital for regular review, the test items mainly include liver function, kidney function, electrolytes, coagulation, for hepatitis B patients according to the specific conditions of the instructions of regular detection of hepatitis B virus markers, hepatitis B virus DNA quantitative timely understanding of the dynamics of the disease, for patients with cirrhosis for more than 5 years or patients with family history of liver disease to detect hepatobiliary pancreatic spleen ultrasound, alpha-fetoprotein, gastroscopy, etc. In addition, close communication with patients to establish a good doctor-patient relationship, increase patient compliance, close and timely attention to the patient's disease dynamics and make an active diagnosis and treatment strategy for this is a vital role in improving the progression and quality of life of patients with cirrhosis.
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