三联营养支持在治疗急性胆源性胰腺炎伴肝损害中的应用  

Application of triple nutrition support in acute biliary pancreatitis patients with liver injury

作　　者：李江海[1] 王宏星[2] 

机构地区：[1]无锡市第三人民医院普外科,江苏省无锡市214041 [2]无锡市第三人民医院临床营养科,江苏省无锡市214041

出　　处：《世界华人消化杂志》2015年第16期2619-2623,共5页World Chinese Journal of Digestology

摘　　要：目的:研究还原型谷胱甘肽、大承气汤联合ω-3鱼油脂肪乳联合营养支持方案在治疗急性胆源性胰腺炎伴肝损害中的作用.方法:将71例经过筛选符合要求急性胆源性胰腺炎住院患者按照随机数字表法随机分为对照组(n=35)和研究组(n=36),所有患者入院后均予常规综合治疗,包括吸氧、禁食、胃肠减压、抑制胰腺分泌及胰酶活性、抑制胃酸分泌、维持水电解质酸碱平衡、抗感染、维护重要脏器功能.两组均按照20-25 kcal/(kg·d)供应肠外营养支持,氮热比为1∶(156.25-178.57),非蛋白热量中糖脂比(50%-60%)∶(40%-50%),对照组采用中/长链脂肪乳注射液,研究组采用ω-3鱼油脂肪乳注射液,研究组同时联合还原型谷胱甘肽注射粉末1200 mg+100 m L氯化钠溶液每日1次静脉滴注以及大承气汤每日100 m L鼻空肠管滴注.于入院时及第10天观察两组肝功能、氧化应激损伤指标、炎性指标等变化情况.结果:两组患者第10天丙氨酸转移酶、天冬氨酸转移酶、碱性磷酸酶、γ-谷氨酰转肽酶、血清总胆红素、直接胆红素、血清甘油三酯等肝功能指标、肿瘤坏死因子α、白介素(interleukin,IL)-2、IL-6等炎性指标及超氧化物歧化酶活性及丙二醛等氧化应激损伤指标与入院时变化差值比较,差异均有统计学意义,P<0.05;研究组情况各指标相对较好.结论:在急性胆源性胰腺炎营养支持中,预防肝损害的发生是一项十分重要的工作;还原型谷胱甘肽联合ω-3鱼油脂肪乳结构脂肪乳及大承气汤灌肠能很好改善肝功能和炎症反应及氧化应激损伤,从而能更好地降低急性胆源性胰腺炎伴肝损害的发生率.AIM：To evaluate the effect of the usage of glutathione,Dachengqi decoction and omega-3polyunsaturated fatty acid in acute biliary pancreatitis（ABP） patients with liver injury.METHODS：Seventy-one hospitalized patients were randomly divided into either a control group（n = 35） or a study group（n = 36）.All patients received routine treatments which included oxygen uptake,fasting,gastrointestinal decompression,inhibition of pancreatic secretion and pancreatic enzyme activity,regulation of fluid,electrolytes and acid-base balance,use of antibiotics,and protecting the function of major organs.The two groups were both given parenteral nutrition with an energy of 20-25 kcal/（kg·d）,a ratio of nitrogen to calorie of 1：（156.25-178.57）,and a ratio of carbohydrate to fat of（50-60%）：（40-50%）.Fat was supported by 20%medium chain/long chain triglycerides in the control group,and by omega-3 polyunsaturated fatty acids in the study group.Meanwhile,glutathione（1200mg/d） and Dachenqi decoction were used in the study group.Indexes of liver function,inflammatory factors and oxidative stress injury were compared for the two groups.RESULTS：There was a significant difference in alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,alkaline phosphatase（ALP）,gamma glutamyl transpeptidase（GGT）,total bilirubin（TB）,direct bilirubin（DB）,triglyceride（TG）,tumor necrosis factor（TNF）-α,interleukin（IL）-2,IL-6,superoxide dismutase（SOD） and methane dicarboxylic aldehyde（MDA） between the two groups（P 〈0.05）,all of which favored the study group.CONCLUSION：During nutrition treatment of ABP,preventing liver injury is very important.Glutathione combined with omega-3polyunsaturated fatty acid and Dachengqi decoction can improve liver function,inflammatory factors and oxidative stress injury,and thereby reduce the incidence rate of liver injury in ABP patients.

关 键 词：急性胆源性胰腺炎 营养支持 肝损害 还原型谷胱甘肽 大承气汤 Ω-3鱼油脂肪乳 

分 类 号：R576[医药卫生—消化系统]