Perioperative nutritional support and nursing care for a patient with rectal cancer and alcoholic liver cirrhosis who developed Wernicke encephalopathy after surgery
1例直肠癌合并酒精性肝硬化患者术后并发韦尼克脑病的围手术期营养支持护理

摘要

本文报道一例67岁男性直肠癌合并酒精性肝硬化患者术后并发韦尼克脑病的围手术期营养支持护理。患者术前长期酗酒（1000mL/d），存在严重营养不良（体重下降5.8%，白蛋白31.3g/L），术后第11日突发意识障碍，结合腱反射消失及维生素B1水平显著降低（0.8nmol/L），确诊韦尼克脑病。围术期采用多学科协作模式，分阶段实施营养干预：术前予戒酒，高蛋白口服营养补充（ONS）；术后早期启动肠内营养（短肽配方+益生菌），联合肠外营养支持；针对并发症调整方案，如暂停含葡萄糖配方、静脉补充维生素B1（500mg bid）。通过干预，患者营养指标显著改善（白蛋白升至30.63g/L，前白蛋白185mg/L），神经症状缓解，感染控制后于术后27天出院。本案例提示，对合并肝硬化的肿瘤患者，术前筛查维生素B1水平、早期个体化营养支持及多学科协作可有效优化预后，为复杂共病患者的围术期管理提供实践参考。

Abstract

This article reports the perioperative nutritional support and nursing care for a 67-year-old male patient with rectal cancer and alcoholic liver cirrhosis who developed Wernicke encephalopathy after surgery. The patient had a long history of heavy drinking (1000mL/d) before the operation and severe malnutrition (weight loss of 5.8%, albumin of 31.3g/L). On the 11th day after the operation, the patient suddenly developed consciousness disorders. Combined with the disappearance of tendon reflexes and a significant decrease in vitamin B1 level (0.8nmol/L), Wernicke encephalopathy was diagnosed. During the perioperative period, a multidisciplinary collaboration model was adopted, and nutritional intervention was implemented in stages: preoperative alcohol cessation and high-protein oral nutritional supplementation (ONS); early initiation of enteral nutrition (short peptide formula + probiotics) combined with parenteral nutrition support; adjustment of the plan for complications, such as suspending glucose-containing formulas and intravenous supplementation of vitamin B1 (500mg bid). Through intervention, the patient's nutritional indicators significantly improved (albumin increased to 30.63g/L, prealbumin 185mg/L), neurological symptoms were relieved, and infection was controlled. The patient was discharged 27 days after the operation. This case suggests that for tumor patients with liver cirrhosis, preoperative screening of vitamin B1 levels, early individualized nutritional support, and multidisciplinary collaboration can effectively optimize prognosis, providing practical reference for the perioperative management of patients with complex comorbidities.