营养支持加生长抑素对重症胰腺炎的治疗作用  

The effect of nutrition support with somatostatin in patients with severe pancreatitis

作　　者：徐鹏远[1] 陈加勇[1] 许世才[1] 谭晶[1] 王兴贤[1] 

机构地区：[1]昆明医学院附属二院普外科,650101

出　　处：《中国临床营养杂志》2000年第1期62-63,共2页Chinese Journal of Clinical Nutrition

摘　　要：目的了解营养支持和生长抑素对重症胰腺炎的治疗作用。方法近2年来对10倒重症胰腺炎给予营养支持和生长激素治疗（治疗组），并与早期仅用TPN支持的10侧重症胰腺炎（对照组）进行比较。所有病人均经淀粉酶、B超、CT及腹腔穿刺液确诊，根据APACHEⅡ评分，＞9分为重症胰腺炎。结果两组病人各有1例死亡，差异无显著性，但治疗组并发症较少，住院时间缩短，与对照组比较差异有显著性P＜0．05。结论1．重症胰腺炎是胸外营养支持的适应证，而轻型胰腺炎可不必给予肠外营养支持，因此急性胰腺炎的临床分级是十分重要的，APACHⅡ评分能较全面地对此作出评价。2.PN能改善重症胰腺炎病人的营养状态，减少胰腺和消化液的分泌，但并不能达到理想的效果。3.生长抑素能明显抑制胰腺及消化道分泌，与PN合用能减少病人并发症发生率，缩短住院时间。4．应注意保护重症胰腺炎的胃肠道粘膜屏障功能，这对阻断或减轻全身炎性反应综合症有重要意义，早期少量口服谷氨酰胺是可取的，且未见增加胰腺负担，有条件者静脉给予足量谷氨酰双肽更好。5.急性胰腺炎病重期给予静脉输注血浆白蛋白十分重要，它能强化PN治疗，及时提高血浆胶体渗透压，发挥白蛋白运输和抗氧化等生理作用。6．手术病人应置空肠造瘘。objective To evaluate the effect of Nutrtion Support with Somatostatin for patients with severe pancreantitis (Acute Hemorrhagic pancreantitis). Methods In a two years pered,we selected 20 patients with severe mpcreantitis,and divided them into two groups randomly. In group A (the treating group), we used TPN Plus Somabotin, In group B (the contro group), we just used the traditional TPN support. All the patients in the study were diagned by serum amylase, ultrasond detection, CT and peritoneocentesis.Their APAC Ⅱ score were all above 9 and confirm to be sevre pancreantitis. Results There was one patient died in each group, the mortality was no significant. But the occurrence of complicatbo of rv A was decreased, and the length of in hospital was stay shortened (P <0. 05 ). Conclusions 1. TPN could meet the hypermetaboic ned of the patients with severe pancreantitis,but it was no necessary for those who just had moderate acute pancreantitis. So the APAC Ⅱ Grade was very important to condition assessment and the selection of candidates for TPN. 2. PN could impruve the nutrition state of the potients with severe pancreantitis,reduce the excretion of pancreas and other digestive glands,but it could not achieve the bot results for signle using. 3. Somatostatin could obviousy compress the excretbo of pancrea and digffitive tractS,the administratbo of it plus PN can cut down the occurrence' of complication and shorten the treating days. 4. To protect the gasric and intestind mucous batrier is crucial, it would be helpful in obstructing and alleviate the Systemic Infiammatory Response Syndrome (SIRS). We have observed that taking low-dose glutamine in early stage of sevre pancreantitis didn' t aggravate the burden of panreas,and the intravenous injection of dipeptid glutamine had much better results. 5. It was also important for severe patients to be given plasma albumin by intravenous drops. It could strengthen the effect of PN, heighten the Plasmatic Coloid Osmotic Pressre,and had the effect of transportation and

关 键 词：重症胰腺炎 治疗作用 生长抑素 营养支持 

分 类 号：R459.3[医药卫生—治疗学]