近年来,由人类免疫缺陷病毒(HIV) 感染所致的获得性免疫缺陷综合征(AIDS) 的患病率在我国呈上升趋势。鉴于
我国医务工作者对艾滋病的诊治经验不多,因此提高对HIV感染的认识很有必要。据报道,在AIDS 患者中,98 %存在营养不良。[1]为此,本文结合近期文献对HIV 感染或艾滋病患者的营养不良发生机理、营养评估及其处理对策综述如下。
1 营养不良发生机理
发生营养不良主要有三个方面的原因:即经口摄入减少,物质代谢改变以及营养成分吸收障碍。
1. 1 经口摄入减少
1. 2 物质代谢的改变
1. 3 吸收障碍
2 营养状况的评估
2. 1 病史
2. 2 食欲
2. 3 体重和身体各部位的测量
2. 4 生化检验
3 营养不良的护理
3. 1 病因护理
3. 1. 1 摄入减少
3. 1. 2 物质代谢改变
3. 1. 3 营养吸收障碍
3. 2 临床护理
3. 2. 1 对症护理
3. 2. 2 一般营养指导
3. 3 心理护理
3. 4 体育锻炼
参 考 文 献
1 Abrams B ,Duncan D ,Hertz - Picciotta I. A prospective study of dietary intake and acquired immune deficiency syndrome in HIV - seropositive ho2 mosexualmen. J Acquir Defic Syndr ,1993 ,6 :949 - 958.
2 Forse RA ,Bell SJ ,Kabbash LG. Diet ,Nutrition ,and Immunity. Boca Ra 2ton :FL ,CRC Press ,1994. 115 - 126.
3 Feingold KR ,Adi S ,Staprans I ,et al . Diet affects the mechanism by which TNF stimulates hepatic triglyceride production. Am J Physiol ,1990 ,259 :
E177 - E184.
4 Macallan DC ,Noble C ,Baldwin C ,et al . Energy expenditure and wasting in human immunodeficiency virus infection. N Engl J Med ,1995 ,333 :83- 85.
5 Grunfeld C ,Feingold KR. Metabolic disturbances and wasting in the ac2 quired immunodeficiency syndrome. N Engl J Med ,1992 ,327 :329 - 337.
6 Hellerstein MK,Grunfeld C ,Wu Ket al . Increased de novo hepatic lipoge2 nesis in human immunodeficiency virus infection. J Clin Endocrinol Metab ,1993 ,76 :559 - 565.
7 Koch J , Garcia - Shelton YL ,Neal EA , et al . Steatorrhea :A commom manifestation in patients with HIV/ AIDS. Nutrition ,1996 ,12 :507 - 510.
8 Chlebowski RT ,Grosvenor MB ,Bernhard NH ,et al . Nutrition status ,gas2 trointestinal dysfunction ,and survival in patients with AIDS. Am J Gas2 troenterol , 1989 ,84 :1288 - 1293.
9 Ott M,Lembcke B ,Fisher H ,et al . Early changes of body composition in human immunodeficiency virus - infected patients : Tetrapolar body impedance analysis indicates significant malnutrition. Am J Clin Nutri ,1993 ,57 :15 - 19.
10 Trujillo EB ,Borlase BC ,Bell SJ ,et al . Assessment of nutritional status ,nutient intake ,and nutrition support in AIDS patients. J Am Diet Assoc ,1992 ,92 :477 - 478.
11 Guentar PA ,Muurahainen N ,Cohan CR , et al . Relationships among nu2 tritional status ,disease progression and survival in HIV infection. J Acquir Immune Defic Syndr ,1993 ,6 :1130 - 1138.
12 Baum MK,Shor - Posner G,Lu Y, et al . Micronutrients and HIV - 1 disease progression. AIDS ,1995 ,9 :1051 - 1056.
13 Byrne TA ,Morrissey TB ,Nattakom TV , et al . Growth hormone , glu2 tamine ,and a modified diet enhance nutrient absorption in patients with severe short bowel syndrome. J PEN J Prenter Enteral Nutr ,1995 ,19 :296 - 302.
14 Roderer M,Ela SW,Staal FJT ,et al . N - acetycysteine :A new approach to anti - HIV therapy. AIDS Res Hum Retroviruses ,1992 ,8 :209 - 215.
15 Wanke CA , Pleskow D , Paola C ,et al . A medium chain triglyceride -based diet in patients with HIV and chronic diarrhea reduces diarrhea andmalabsorption :A prospective ,controlled trial . Nutrition ,1996 ,11 :766 -771.
16 Gerrior JL ,Bell SJ ,Wanke CA. Oral nutrition for the patient with HIV infection. Nurs Clin of North Am,1997 ,32 :813 - 830 |