重症急性胰腺炎全胃肠外营养(TPN)支持治疗45例分析  

Total parenteral nutrition using in the severe acute pancreatitis:reprot of 45 cases

作　　者：张军[1] 王严庆[1] 

机构地区：[1]重庆医科大学附属第一医院,400016

出　　处：《重庆医学》2004年第6期896-898,共3页Chongqing medicine

摘　　要：目的　总结以全胃肠外营养 (TPN)支持治疗为主的重症急性胰腺炎的临床经验。方法　回顾性分析 4 5例重症急性胰腺炎的病情、TPN治疗及其它综合治疗情况。结果　患者病情大多重危 ,病程长 ,平均 6 4d ,最长 1 79d ,并发症多 ,代谢紊乱和营养问题突出。用TPN进行代谢营养支持平均 2 3 8d ,最长 72d ,多数从病程早期开始 ,覆盖整个消化道功能障碍时期 ,直到恢复经肠营养。综合治疗包括早期抗休克和多脏器功能支持 ,以及其它内科救治措施 ,1 0d内行手术引流 2 2例 ,术中或 /和后胰床和腹腔灌洗 1 3例 ,后期胰腺脓肿引流及坏死组织清除 1 1例。 39例治愈 (86 7% ) ,死亡 6例 (1 3 3% ) ,死因为胰腺脓毒症并发感染性休克 4例、衰竭合并肺部感染而发生多脏器功能不全 2例。结论　TPN是重症急性胰腺炎的基本治疗措施 ,应从病程早期开始 ,覆盖整个消化道功能障碍时期 。Objective To summarize the experience of clinical use of TPN as the supporting treatment for patients with severe acute pancreatitis.Methods A total of 45 patients with pancreatitis were analyzed retrospectively for their clinical course,especially the effect of TPN and the other modality of treatment.Results Most of the patients′ illness were severe and critical.The clinical course were long and complicated,lasting 64 days on average with the longest 179 days.The problems of malnutrition and metabolic disturbance were obvious.The mean duration of TPN support was 23.8 days with the longest 72 days.For the majority of patients,TPN started early in their course of disease and mainatained it throughout the whole period of alimentary dysfunction till enteral nutrition could be adopted.The comprehensive treatment,including anti shock treatment and supporting of the functions of multiple organs,and other conservative treatment,was carrried out.Twenty two patients received early operative drainage within ten days,among them intraoperative and/or postoperative peritoneal lavage were done in 13 cases.Eleven patients underwent operative drainage or débridement for their pancreatic abscesses in the later stage.Thirty eight patients were cured(86.7%),six died(13.3%),of who 4 dying of pancreatic sepsis resulting in spetic shock,2 of exhaustion and pulmonary infection.Conclusion TPN is an essential treatment for severe acute pancreatitis,it must start early in the course of disease and be maintained throughout the whole alimentary dysfunction period till enteral nutrition can be utilized.

关 键 词：全胃肠外营养 重症急性胰腺炎 

分 类 号：R65751[医药卫生—外科学]