肠内营养支持对急性胰腺炎病程的影响  

Effect of enteral nutrition on the course of acute pancreatitis

作　　者：张红[1] 陈昶铭[2] 王炳元[2] 

机构地区：[1]鞍山市传染病院,辽宁鞍山110114 [2]中国医科大学附属第一医院消化内科,辽宁沈阳110001

出　　处：《现代医药卫生》2005年第13期1624-1626,共3页Journal of Modern Medicine & Health

摘　　要：目的:观察肠内营养支持治疗对急性胰腺炎(AP),尤其是重症急性胰腺炎(SAP)病程的影响。方法:对确诊为AP者118例,男77例,女41例,年龄14～65岁。轻、中度者104例,重度14例。(1)常规治疗:SAP患者给予生长抑素、小牛胸腺肽等。(2)营养支持:对于轻症的AP患者,48～72小时疼痛明显缓解后开始经口给与营养;对于中度的、非胆源性AP患者3～4天后给与EN支持,即经内镜引导下将鼻空肠管置入Treitz韧带以下,将营养成分持续泵入空肠;对于严重胆源性的AP或SAP患者首选TPN治疗,待炎症明显控制、症状相对稳定之后(一般4～7天),动员患者进行EN治疗。结果:轻度AP患者72小时内有74.0%(57/77)的病例腹痛症状消失,平均住院日为10天;中度AP患者中有9例接受了EN治疗,平均住院日为14天,而接受TPN治疗者为24天(最长达39天);14例SAP患者开始都进行TPN等综合治疗,10例接受EN维持治疗后,体力和精神状态恢复较快,症状逐渐缓解,SIRS及MOF也能较快控制,其中2例带管在家行肠内营养达2月余(分别为66天和72天)。接受TPN的患者中有4例发生不同程度的肝功能损害,而EN未见明显不良反应。结论:AP患者早期的营养支持治疗,患者不仅体力和精神状态明显恢复,血、尿淀粉酶稳定下降,住院天数缩短;TPN结合EN的综合治疗可能是更有益的。Objective:To investigate the effect of enteral nutrition on the course of acute pancreatitis(AP),especially on the severe acute pancreatitis(SAP).Methods:To retrospective analysis of118AP patients from August2001to November2004,77cases were male and41cases were female,age ranged from14to65years old.Among them,104patients were mild to moderate AP,14patients were SAP,(1)Routine treatˉment;(2)Nutrition support:For mild AP,after48-72hours,when the pain relieved,oral nutrition intake began.For moderate and nonbiliary AP,enteral nutrition(EN)began,Viz.placed nasal-jejunum tube belowTreitz ligament by endoscope,pumped the nutrition into jejunum continuˉously.For the severe biliary AP or SAP,total parenteral nutrition(TPN)was the first choice,when the inflammation was controlled,symptoms was stabilized(about4～7days),EN treatment was essential.Results:For mild AP patients,about74.0%(57/77)patients disappear the symptom of abdominal pain within72hours,average hospitalized time are10days.For the27moderate AP patients,9patients accepted ENtreatment,average hospitalized time are14days,for the else TPN treatment group,average hospitalized time are24days(the longest are39days).For the14SAP patients,they all accepted integrated treatment including TPN from the beginning,10of them accepted the following EN treatment,physical strength and spirit renewfast,symptoms relieved gradually,systemic inflammatory response syndrome(SIRS)and multiple organ failure(MOF)can be controlled rapidly,two patients take the nutrition tube as long as66and72days at home.For the patients who accepted TPN treatment,4of them appear liver damage,while the EN treatment group have no adverse effect.Conclusion:Early nutrition support is very important for AP paˉtients,physical strength and spirit renewfast,amylase in blood and urine drop stably,shorten the hospitalized time.It is more beneficial for the combination of EN and TPN treatment.

关 键 词：急性胰腺炎 营养支持 全肠道外营养 肠内营养 尿淀粉酶 

分 类 号：R657.51[医药卫生—外科学] R459.3[医药卫生—临床医学]