全腸內營養支持對急性重癥胰腺炎患者預后影響的臨床觀察_《華西醫學》

作者：

周晏林 ¹ , 杜蓉 ² , 肖光榮 ¹

1 都江堰市人民醫院普外科（成都，611830）;2 成都大學醫護學院;

關鍵詞：

急性重癥胰腺炎全腸內營養全腸外營養預后

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【摘要】　目的　探討比較全腸內營養支持和全腸外營養支持對急性重癥胰腺炎（severe acute pamcreattis，SAP）預后的影響。　方法　將2003年1月-2008年12月收治的54例SAP患者于入院后第1周內隨機分為兩組:全腸內營養（A）組27例；全腸外營養（B）組27例。兩組患者均靜脈給予廣譜抗生素預防感染。入院時CT掃描及C反應蛋白水平顯示兩組患者具有可比性。　結果　 B組22例患者發生器官衰竭，明顯高于A組（5例）。B組22例患者接受了手術治療，A組手術患者6例（P lt;0.05）。A組患者胰腺壞死后感染發生率明顯低于B組（P lt;0.05）。B組患者死亡率高于A組（P lt;0.05）。　結論　全腸內營養支持，不僅可以促進腸道功能的恢復和營養狀況的維持，還可減少腸源性感染的發生率，對減少SAP的感染性并發癥和病死率具有積極作用。
【Abstract】　Objective　 To evaluate the effects of total enteral nutrition and total parenteral nutrition on the prognosis on severe acute pancreatitis (SAP).　Methods　 A total of 54 patients hospitalized from January 2003 to December 2008 were enrolled. In the first week of hospitalization, the patients were randomly divided into two groups: 27 patients in total parenteral nutrition group (group A) and 27 patients in total enteral nutrition group (group B). All patients were administered with sufficient prophylactic antibiotics. The results of CT scan and C-reactive protein levels were comparable between the two groups.　Results　 Twenty-two patients had organ failure in group B, which was much higher than that in group A (five patieuts). The numbers of the patients undertwent surgical intervention in group A and B were 22 and 6 (P lt;0.05). The incidence of infection after pancreatic septic necroses in group A was obviously lower than that in group B (P lt;0.05). The mortality in group B was apparently higher than that in group A (P lt;0.05).　Conclusion　 Total enteral nutrition support can not only promote the functional recovery of intestinal tract and sustain the nutrition of human body,but also decrease the incidence of enterogenic infection.

引用本文： 周晏林,杜蓉,肖光榮. 全腸內營養支持對急性重癥胰腺炎患者預后影響的臨床觀察. 華西醫學, 2010, 25(12): 2185-2188. doi: 復制

1.	王興鵬. 加強重癥急性胰腺炎腸內營養的臨床研究[J]. 中華醫學雜志, 2004, 84(15): 1233-1234.
2.	王興鵬, 許國銘, 袁宗耀, 等. 中國急性胰腺炎診治指南(草案) [J]. 中華消化雜志, 2004, 24 (3): 190-192.
3.	Friedman LS. Liver, biliary tract and pancreas//Tierney LM, McPhee SJ, Papadakis MA. Current Medical Diagnosis and Treatment[M]. 45th ed. New York, NY: Lange Medical Books/McGraw-Hill, 2006: 693-701.
4.	Berzin TM, Rocha FG, Whang EE, et al. Prevalence of primary fungal infections in necrotizing pancreatitis[J]. Pancreatology, 2007, 7(1): 63-66.
5.	Lehocky P, Sarr MG. Early enteral feeding in severe acute pancreatitis: can it prevent secondary pancreatic (super) infection? [J]. Dig Surg, 2000, 17(6): 571-577.
6.	Gmen E, Klc YA, Yolda O, et al. Comparison and validation of scoring systems in a cohort of patients treated for biliary acute pancreatitis[J]. Pancreas, 2007, 34(1): 66-69.
7.	Rahman SH, Menon KV, Holmfield JH, et al. Serum macrophage migration inhibitory factor is an early marker of pancreatic necrosis in acute pancreatitis[J]. Ann Surg, 2007, 245(2): 282-289.
8.	Powell JJ, Murchison JT, Fearon KC, et al. Randomized controlled trial of the effect of early enteral nutrition on markers of the inflammatory response in predicted severe acute pancreatitis[J]. Br J Surg, 2000, 87(10): 1375-1381.
9.	Büchler MW, Gloor B, Müller CA, et al. Acute necrotizing pancreatitis: treatment strategy according to status of infection[J]. Ann Surg, 2000, 232(5): 619-626.
10.	Isenmann R, Runzi M, Kron M, et al. Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: a placebo-controlled, double-blind trial[J]. Gastroenterology, 2004, 126(4): 997-1004.
11.	De Waele JJ, Delrue L, Hoste EA, et al. Extrapancreatic inflammation on abdominal computed tomography as an early predictor of disease severity in acute pancreatitis: evaluation of a new scoring system[J]. Pancreas, 2007, 34(2): 185-190.
12.	McNaught CE, Woodcock NP, Mitchell CJ, et al. Gastric colonisation, intestinal permeability and septic morbidity in acute pancreatitis[J]. Pancreatology, 2002, 2(5): 463-468.
13.	Dellinger EP, Tellado JM, Soto NE, et al. Early antibiotic treatment for severe acute necrotizing pancreatitis: a randomized, double-blind, placebo-controlled study[J]. Ann Surg, 2007, 245(5): 674-683.
14.	Schietroma M, Carlei F, Lezoche E, et al. Acute biliary pancreatitis: staging and management[J]. Hepato-gastroenterology, 2001, 48(40): 988-993.
15.	Kumar A, Singh N, Prakash S, et al. Early enteral nutrition in severe acute pancreatitis: a prospective randomized controlled trial comparing nasojejunal and nasogastric routes[J]. J Clin Gastroenterol, 2006, 40(5): 431-434.
16.	Baril NB, Ralls PW, Wren SM, et al. Does an infected peripancreatic fluid collection or abscess mandate operation? [J]. Ann Surg, 2000, 231(3): 361-367.

1. 　王興鵬. 加強重癥急性胰腺炎腸內營養的臨床研究[J]. 中華醫學雜志, 2004, 84(15): 1233-1234.
2. 　王興鵬, 許國銘, 袁宗耀, 等. 中國急性胰腺炎診治指南(草案) [J]. 中華消化雜志, 2004, 24 (3): 190-192.
3. 　Friedman LS. Liver, biliary tract and pancreas//Tierney LM, McPhee SJ, Papadakis MA. Current Medical Diagnosis and Treatment[M]. 45th ed. New York, NY: Lange Medical Books/McGraw-Hill, 2006: 693-701.
4. 　Berzin TM, Rocha FG, Whang EE, et al. Prevalence of primary fungal infections in necrotizing pancreatitis[J]. Pancreatology, 2007, 7(1): 63-66.
5. 　Lehocky P, Sarr MG. Early enteral feeding in severe acute pancreatitis: can it prevent secondary pancreatic (super) infection? [J]. Dig Surg, 2000, 17(6): 571-577.
6. 　Gmen E, Klc YA, Yolda O, et al. Comparison and validation of scoring systems in a cohort of patients treated for biliary acute pancreatitis[J]. Pancreas, 2007, 34(1): 66-69.
7. 　Rahman SH, Menon KV, Holmfield JH, et al. Serum macrophage migration inhibitory factor is an early marker of pancreatic necrosis in acute pancreatitis[J]. Ann Surg, 2007, 245(2): 282-289.
8. 　Powell JJ, Murchison JT, Fearon KC, et al. Randomized controlled trial of the effect of early enteral nutrition on markers of the inflammatory response in predicted severe acute pancreatitis[J]. Br J Surg, 2000, 87(10): 1375-1381.
9. 　Büchler MW, Gloor B, Müller CA, et al. Acute necrotizing pancreatitis: treatment strategy according to status of infection[J]. Ann Surg, 2000, 232(5): 619-626.
10. 　Isenmann R, Runzi M, Kron M, et al. Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: a placebo-controlled, double-blind trial[J]. Gastroenterology, 2004, 126(4): 997-1004.
11. 　De Waele JJ, Delrue L, Hoste EA, et al. Extrapancreatic inflammation on abdominal computed tomography as an early predictor of disease severity in acute pancreatitis: evaluation of a new scoring system[J]. Pancreas, 2007, 34(2): 185-190.
12. 　McNaught CE, Woodcock NP, Mitchell CJ, et al. Gastric colonisation, intestinal permeability and septic morbidity in acute pancreatitis[J]. Pancreatology, 2002, 2(5): 463-468.
13. 　Dellinger EP, Tellado JM, Soto NE, et al. Early antibiotic treatment for severe acute necrotizing pancreatitis: a randomized, double-blind, placebo-controlled study[J]. Ann Surg, 2007, 245(5): 674-683.
14. 　Schietroma M, Carlei F, Lezoche E, et al. Acute biliary pancreatitis: staging and management[J]. Hepato-gastroenterology, 2001, 48(40): 988-993.
15. 　Kumar A, Singh N, Prakash S, et al. Early enteral nutrition in severe acute pancreatitis: a prospective randomized controlled trial comparing nasojejunal and nasogastric routes[J]. J Clin Gastroenterol, 2006, 40(5): 431-434.
16. 　Baril NB, Ralls PW, Wren SM, et al. Does an infected peripancreatic fluid collection or abscess mandate operation? [J]. Ann Surg, 2000, 231(3): 361-367.

《華西醫學》

全腸內營養支持對急性重癥胰腺炎患者預后影響的臨床觀察

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《華西醫學》

全腸內營養支持對急性重癥胰腺炎患者預后影響的臨床觀察

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