老年重症急性胰腺炎患者空肠营养时肠道不耐受原因及处理  

Enteral feeding intolerance in senile patients with severe acute pancreatitis:causes and management

作　　者：邓漾[1] 韩天权[1] 沈冬威[1] 雷若庆[1] 吴卫泽[1] 王建承[1] 陈胜[1] 陈曦[1] 费健[1] 朱坚[1] 许志伟[1] 张卓[1] 张圣道[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院外科,200025

出　　处：《老年医学与保健》2008年第5期264-266,共3页Geriatrics & Health Care

摘　　要：目的探讨老年(年龄≥60岁)重症急性胰腺炎(SAP)患者营养治疗中肠道不耐受的原因和防治。方法回顾研究2006年1月至2007年11月128例重症急性胰腺炎行空肠营养治疗出现的肠道不耐受现象。其中老年患者56例,非老年72例。结果56例老年SAP,11例出现肠道不耐受,对照组(年龄<60岁)72例,4例出现肠道不耐受;老年组肠道不耐受发生率与对照组比较差异有统计学意义。老年组肠道不耐受患者经非手术处理,5例肠道不耐受症状消失:其中3例使用肠内输液泵(flocare 800 pump)、一次性肠内营养输注器以及加热器,2例降低营养液滴注浓度。老年组6例转为手术治疗,发现5例伴小肠充血水肿,1例小肠部分缺血坏死;5例存在胰周感染,术后5例耐受肠内营养支持治疗。结论老年SAP肠内营养治疗中,肠道不耐受的发生率较高,其原因与营养液滴注速度、浓度和温度有关。老年SAP肠内营养使用过程中应特别注意肠功能障碍的发生,及时行胰腺坏死组织清创引流减压是防治肠功能障碍及恢复肠道营养治疗的重要措施。Objective To investigate causes and management of enteral feeding intolerance in senile patients with severe acute pancreatitis （SAP）. Methods Clinical data of 128 SAP patients （56 older than 60 years） who received enteral feeding treatment between January 2006 and November 2007 were analyzed retrospectively. Results The enteral feeding intolerance rate was significantly higher in the senile group （11/56 or 19.6%） than that in the control group （4/72 or 5.5 %）. Five old patients presented with enteral feeding intolerance symptoms, which were relieved by non-surgical treatment, including application of Flocare 800 pump, single-use enteral feeding tube and heater in 3 patients, and enteral nutrition fluid dilution in the remaining 2 patients. Six senile patients developed enteral feeding intolerance and converted to laparotomic exploration, finding hyperemia and edema of intestinal wall in 5 patients and necrosis of small intestine in the remaining patient. In addition, peri-pancreatic infection was found in 5 of the 6 patients, whose enteral feeding intolerance was alleviated by necrosectomy and debridement. Conclusions The enteral feeding intolerance rate was higher in senile SAP patients. The possible risk factors were the infusion rate, temperature and concentration of the nutritional fluid. Intestinal dysfunction should be watched timely during enteral nutritional support, and necrosectomy should be considered as a strategy to prevent intestinal dysfunction and early restart enteral nutrition support.

关 键 词：老年人 胰腺炎 急性病 肠饲 肠疾病 

分 类 号：R576[医药卫生—消化系统]