目的 探討早期腸內營養（EN）在重癥急性胰腺炎（SAP）治療中的可行性、安全性及對預后的影響。
方法 復習近年早期EN在SAP治療中應用的研究成果并進行綜述。
結果 對SAP患者空腸置管行早期EN能維護腸黏膜屏障的完整性，減少感染并發癥，但對于EN的開始時機、配方、輸注方式等仍然存在爭議。
結論 早期EN在SAP的治療中有積極的作用，但仍有待深入的研究。
引用本文： 董亮,康焰. 早期腸內營養在重癥急性胰腺炎治療中的應用. 中國普外基礎與臨床雜志, 2008, 15(8): 567-571. doi: 復制
| 1. | Kotani J, Usami M, Nomura H, et al. Enteral nutrition prevents bacterial translocation but does not improve survival during acute pancreatitis [J]. Arch Surg， 1999; 134(3)∶287. |
| 2. | Windsor AC, Kanwar S, Li AG, et al. Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis [J]. Gut, 1998; 42(3)∶431. |
| 3. | 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. |
| 4. | Eckerwall GE, Axelsson JB, Andersson RG. Early nasogastric feeding in predicted severe acute pancreatitis: A clinical, randomized study [J]. Ann Surg, 2006; 244(6)∶959. |
| 5. | 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. |
| 6. | 李維勤， 黎介壽. 重癥急性胰腺炎患者的階段性營養支持策略 [J]. 江蘇臨床醫學雜志， 2002; 6（2）∶96. |
| 7. | Heinrich S, Schfer M, Rousson V, et al. Evidence-based treatment of acute pancreatitis: a look at established paradigms [J]. Ann Surg, 2006; 243(2)∶154. |
| 8. | Tellado JM. Prevention of infection following severe acute pancreatitis [J]. Curr Opin Crit Care, 2007; 13(4)∶416. |
| 9. | 李寧， 黎介壽. 外科營養近20年的進展與展望 [J]. 中國實用外科雜志， 2002； 22（1）∶6. |
| 10. | 秦環龍， 蘇振東， 胡雷光， 等. 早期腸內營養對犬重癥急性胰腺炎自然病程和腸道屏障功能的影響 [J]. 中國普外基礎與臨床雜志， 2002； 9（5）∶325. |
| 11. | Casas M, Mora J, Fort E, et al. Total enteral nutrition vs. total parenteral nutrition in patients with severe acute pancreatitis [J]. Rev Esp Enferm Dig, 2007; 99(5)∶264. |
| 12. | Jiang K, Chen XZ, Xia Q, et al. Early nasogastric enteral nutrition for severe acute pancreatitis: a systematic review [J]. World J Gastroenterol, 2007; 13(39)∶5253. |
| 13. | 秦環龍. 腸外與腸內營養對胰腺外分泌和急性重癥胰腺炎的影響 [J]. 腸外與腸內營養, 2001; 8(4)∶240. |
| 14. | Kalfarentzos F, Kehagias J, Mead N, et al. Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: results of a randomized prospective trial [J]. Br J Surg, 1997; 84(12)∶1665. |
| 15. | Wittmann T, Róka R, Palágyi P, et al. Continuous enteral feeding has an attenuating effect on the exocrine pancreas in rats [J]. Pancreas, 2001; 23(3)∶329. |
| 16. | Hamvas J, Schwab R, Pap A. Jejunal feeding in necrotising acute pancreatitis—a retrospective study [J]. Acta Chir Hung, 1999; 38(2)∶177. |
| 17. | 王興鵬. 重癥急性胰腺炎患者實施早期腸內營養的可能性及其理論基礎 [J]. 胰腺病學， 2002； 2（3）∶171. |
| 18. | 劉曉臣, 彭燕. 腸屏障功能障礙與重癥急性胰腺炎 [J]. 世界華人消化雜志, 2006; 14(32)∶3131. |
| 19. | Gupta R, Patel K, Calder PC, et al. A randomised clinical trial to assess the effect of total enteral and total parenteral nutritional support on metabolic, inflammatory and oxidative markers in patients with predicted severe acute pancreatitis (APACHE Ⅱ ＞or=6) [J]. Pancreatology, 2003; 3(5)∶406. |
| 20. | Kudsk KA, Li J, Renegar KB. Loss of upper respiratory tract immunity with parenteral feeding [J]. Ann Surg, 1996; 223(6)∶629. |
| 21. | Janu P, Li J, Renegar KB, et al. Recovery of gut-associated lymphoid tissue and upper respiratory tract immunity after parenteral nutrition [J]. Ann Surg， 1997; 225(6)∶707. |
| 22. | King BK, Li J, Kudsk KA. A temporal study of TPN-induced changes in gut-associated lymphoid tissue and mucosal immunity [J]. Arch Surg， 1997; 132(12)∶1303. |
| 23. | Li J, Kudsk KA, Gocinski B, et al. Effets of parenteral and enteral nutrition on gut-associated lymphoid tissue [J]. J Trauma， 1995; 39(1)∶44. |
| 24. | Qin HL, Su ZD, Hu LG, et al. Effect of early intrajejunal nutrition on pancreatic pathological features and gut barrier function in dogs with acute pancreatitis [J]. Clin Nutr, 2002; 21(6)∶469. |
| 25. | O’Dwyer ST, Michie HR, Ziegler TR, et al. A single dose of endotoxin increases intestinal permeability in healthy humans [J]. Arch Surg, 1988; 123(12)∶1459. |
| 26. | 萬獻堯, 于凱江, 馬曉春, 等. 中國重癥加強治療病房危重患者營養支持指導意見(2006) [J]. 中華外科雜志, 2006; 44(17)∶1167. |
| 27. | Cassim MM, Allardyce DB. Pancreatic secretion in response to jejunal feeding of elemental diet [J]. Ann Surg, 1974; 180(2)∶228. |
| 28. | Vu MK, van der Veek PP, Frlich M, et al. Does jejunal feeding activate exocrine pancreatic secretion? [J]. Eur J Clin Invest, 1999; 29(12)∶1053. |
| 29. | Abou-Assi S, Craig K, OKeefe SJ. Hypocaloric jejunal feeding is better than total parenteral nutrition in acute pancreatitis: results of a randomized comparative study [J]. Am J Gastroenterol, 2002; 97(9)∶2255. |
| 30. | Ragins H, Levenson SM, Signer R, et al. Intrajejunal administration of an elemental diet at neutral pH avoids pancreatic stimulation. Studies in dog and man [J]. Am J Surg, 1973; 126(5)∶606. |
| 31. | Marik PE, Zaloga GP. Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis [J]. BMJ, 2004; 328(7453)∶1407. |
| 32. | Erstad BL. Enteral nutrition support in acute pancreatitis [J]. Ann Pharmacother, 2000; 34(4)∶514. |
| 33. | Kale-Pradhan PB, Elnabtity MH, Park NJ, et al. Enteral nutrition in patients with pancreatitis [J]. Pharmacotherapy, 1999; 19(9)∶1036. |
| 34. | Karakan T, Ergun M, Dogan I, et al. Comparison of early enteral nutrition in severe acute pancreatitis with prebiotic fiber supplementation versus standard enteral solution: a prospective randomized double-blind study [J]. World J Gastroenterol, 2007; 13(19)∶2733. |
| 35. | van Berge Henegouwen MI, Akkermans LM, van Gulik TM, et al. Prospective, randomized trial on the effect of cyclic versus continuous enteral nutrition on postoperative gastric function after pylorus-preserving pancreatoduodenectomy [J]. Ann Surg, 1997; 226(6)∶677. |
| 36. | Dickerson RN, Vehe KL, Mullen JL, et al. Resting energy expenditure in patients with pancreatitis [J]. Crit Care Med, 1991; 19(4)∶484. |
| 37. | Lobo DN, Memon MA, Allison SP, et al. Evolution of nutritional support in acute pancreatitis [J]. Br J Surg, 2000; 87(6)∶695. |
| 38. | Petrov MS, Kukosh MV, Emelyanov NV. A randomized controlled trial of enteral versus parenteral feeding in patients with predicted severe acute pancreatitis shows a significant reduction in mortality and in infected pancreatic complications with total enteral nutrition [J]. Dig Surg, 2006; 23(5-6)∶336. |
| 39. | Oláh A, Belágyi T, Issekutz A, et al. Combination of early nasojejunal feeding with modern synbiotic therapy in the treatment of severe acute pancreatitis (prospective, randomized, double-blind study) [J]. Magy Seb, 2005; 58(3)∶173. |
| 40. | 吳在德, 吳肇漢主編. 外科學 [M]. 第6版. 北京: 人民衛生出版社， 2004∶148～150. |
| 41. | 吳丹， 婁健穎， 林漢庭. 急性胰腺炎的腸內營養 [J]. 中國實用外科雜志， 2003; 2（23）∶70. |
| 42. | Nakad A, Piessevaux H, Marot JC, et al. Is early enteral nutrition in acute pancreatitis dangerous? About 20 patients fed by an endoscopically placed nasogastrojejunal tube [J]. Pancreas, 1998; 17(2)∶187. |
| 43. | 劉俊， 夏強. 急性重癥胰腺炎早期腸內營養反復失敗1例 [J]. 腸內與腸外營養， 2002； 9（2）∶118. |
| 44. | 伍曉汀， 張肇達， 趙小菲. 重癥急性胰腺炎的營養支持 [J]. 中國普外基礎與臨床雜志， 2004； 11（3）∶273. |
| 45. | Whitcomb DC. Clinical practice. Acute pancreatitis [J]. N Engl J Med, 2006; 354(20)∶2142. |
- 1. Kotani J, Usami M, Nomura H, et al. Enteral nutrition prevents bacterial translocation but does not improve survival during acute pancreatitis [J]. Arch Surg， 1999; 134(3)∶287.
- 2. Windsor AC, Kanwar S, Li AG, et al. Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis [J]. Gut, 1998; 42(3)∶431.
- 3. 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.
- 4. Eckerwall GE, Axelsson JB, Andersson RG. Early nasogastric feeding in predicted severe acute pancreatitis: A clinical, randomized study [J]. Ann Surg, 2006; 244(6)∶959.
- 5. 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.
- 6. 李維勤， 黎介壽. 重癥急性胰腺炎患者的階段性營養支持策略 [J]. 江蘇臨床醫學雜志， 2002; 6（2）∶96.
- 7. Heinrich S, Schfer M, Rousson V, et al. Evidence-based treatment of acute pancreatitis: a look at established paradigms [J]. Ann Surg, 2006; 243(2)∶154.
- 8. Tellado JM. Prevention of infection following severe acute pancreatitis [J]. Curr Opin Crit Care, 2007; 13(4)∶416.
- 9. 李寧， 黎介壽. 外科營養近20年的進展與展望 [J]. 中國實用外科雜志， 2002； 22（1）∶6.
- 10. 秦環龍， 蘇振東， 胡雷光， 等. 早期腸內營養對犬重癥急性胰腺炎自然病程和腸道屏障功能的影響 [J]. 中國普外基礎與臨床雜志， 2002； 9（5）∶325.
- 11. Casas M, Mora J, Fort E, et al. Total enteral nutrition vs. total parenteral nutrition in patients with severe acute pancreatitis [J]. Rev Esp Enferm Dig, 2007; 99(5)∶264.
- 12. Jiang K, Chen XZ, Xia Q, et al. Early nasogastric enteral nutrition for severe acute pancreatitis: a systematic review [J]. World J Gastroenterol, 2007; 13(39)∶5253.
- 13. 秦環龍. 腸外與腸內營養對胰腺外分泌和急性重癥胰腺炎的影響 [J]. 腸外與腸內營養, 2001; 8(4)∶240.
- 14. Kalfarentzos F, Kehagias J, Mead N, et al. Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: results of a randomized prospective trial [J]. Br J Surg, 1997; 84(12)∶1665.
- 15. Wittmann T, Róka R, Palágyi P, et al. Continuous enteral feeding has an attenuating effect on the exocrine pancreas in rats [J]. Pancreas, 2001; 23(3)∶329.
- 16. Hamvas J, Schwab R, Pap A. Jejunal feeding in necrotising acute pancreatitis—a retrospective study [J]. Acta Chir Hung, 1999; 38(2)∶177.
- 17. 王興鵬. 重癥急性胰腺炎患者實施早期腸內營養的可能性及其理論基礎 [J]. 胰腺病學， 2002； 2（3）∶171.
- 18. 劉曉臣, 彭燕. 腸屏障功能障礙與重癥急性胰腺炎 [J]. 世界華人消化雜志, 2006; 14(32)∶3131.
- 19. Gupta R, Patel K, Calder PC, et al. A randomised clinical trial to assess the effect of total enteral and total parenteral nutritional support on metabolic, inflammatory and oxidative markers in patients with predicted severe acute pancreatitis (APACHE Ⅱ ＞or=6) [J]. Pancreatology, 2003; 3(5)∶406.
- 20. Kudsk KA, Li J, Renegar KB. Loss of upper respiratory tract immunity with parenteral feeding [J]. Ann Surg, 1996; 223(6)∶629.
- 21. Janu P, Li J, Renegar KB, et al. Recovery of gut-associated lymphoid tissue and upper respiratory tract immunity after parenteral nutrition [J]. Ann Surg， 1997; 225(6)∶707.
- 22. King BK, Li J, Kudsk KA. A temporal study of TPN-induced changes in gut-associated lymphoid tissue and mucosal immunity [J]. Arch Surg， 1997; 132(12)∶1303.
- 23. Li J, Kudsk KA, Gocinski B, et al. Effets of parenteral and enteral nutrition on gut-associated lymphoid tissue [J]. J Trauma， 1995; 39(1)∶44.
- 24. Qin HL, Su ZD, Hu LG, et al. Effect of early intrajejunal nutrition on pancreatic pathological features and gut barrier function in dogs with acute pancreatitis [J]. Clin Nutr, 2002; 21(6)∶469.
- 25. O’Dwyer ST, Michie HR, Ziegler TR, et al. A single dose of endotoxin increases intestinal permeability in healthy humans [J]. Arch Surg, 1988; 123(12)∶1459.
- 26. 萬獻堯, 于凱江, 馬曉春, 等. 中國重癥加強治療病房危重患者營養支持指導意見(2006) [J]. 中華外科雜志, 2006; 44(17)∶1167.
- 27. Cassim MM, Allardyce DB. Pancreatic secretion in response to jejunal feeding of elemental diet [J]. Ann Surg, 1974; 180(2)∶228.
- 28. Vu MK, van der Veek PP, Frlich M, et al. Does jejunal feeding activate exocrine pancreatic secretion? [J]. Eur J Clin Invest, 1999; 29(12)∶1053.
- 29. Abou-Assi S, Craig K, OKeefe SJ. Hypocaloric jejunal feeding is better than total parenteral nutrition in acute pancreatitis: results of a randomized comparative study [J]. Am J Gastroenterol, 2002; 97(9)∶2255.
- 30. Ragins H, Levenson SM, Signer R, et al. Intrajejunal administration of an elemental diet at neutral pH avoids pancreatic stimulation. Studies in dog and man [J]. Am J Surg, 1973; 126(5)∶606.
- 31. Marik PE, Zaloga GP. Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis [J]. BMJ, 2004; 328(7453)∶1407.
- 32. Erstad BL. Enteral nutrition support in acute pancreatitis [J]. Ann Pharmacother, 2000; 34(4)∶514.
- 33. Kale-Pradhan PB, Elnabtity MH, Park NJ, et al. Enteral nutrition in patients with pancreatitis [J]. Pharmacotherapy, 1999; 19(9)∶1036.
- 34. Karakan T, Ergun M, Dogan I, et al. Comparison of early enteral nutrition in severe acute pancreatitis with prebiotic fiber supplementation versus standard enteral solution: a prospective randomized double-blind study [J]. World J Gastroenterol, 2007; 13(19)∶2733.
- 35. van Berge Henegouwen MI, Akkermans LM, van Gulik TM, et al. Prospective, randomized trial on the effect of cyclic versus continuous enteral nutrition on postoperative gastric function after pylorus-preserving pancreatoduodenectomy [J]. Ann Surg, 1997; 226(6)∶677.
- 36. Dickerson RN, Vehe KL, Mullen JL, et al. Resting energy expenditure in patients with pancreatitis [J]. Crit Care Med, 1991; 19(4)∶484.
- 37. Lobo DN, Memon MA, Allison SP, et al. Evolution of nutritional support in acute pancreatitis [J]. Br J Surg, 2000; 87(6)∶695.
- 38. Petrov MS, Kukosh MV, Emelyanov NV. A randomized controlled trial of enteral versus parenteral feeding in patients with predicted severe acute pancreatitis shows a significant reduction in mortality and in infected pancreatic complications with total enteral nutrition [J]. Dig Surg, 2006; 23(5-6)∶336.
- 39. Oláh A, Belágyi T, Issekutz A, et al. Combination of early nasojejunal feeding with modern synbiotic therapy in the treatment of severe acute pancreatitis (prospective, randomized, double-blind study) [J]. Magy Seb, 2005; 58(3)∶173.
- 40. 吳在德, 吳肇漢主編. 外科學 [M]. 第6版. 北京: 人民衛生出版社， 2004∶148～150.
- 41. 吳丹， 婁健穎， 林漢庭. 急性胰腺炎的腸內營養 [J]. 中國實用外科雜志， 2003; 2（23）∶70.
- 42. Nakad A, Piessevaux H, Marot JC, et al. Is early enteral nutrition in acute pancreatitis dangerous? About 20 patients fed by an endoscopically placed nasogastrojejunal tube [J]. Pancreas, 1998; 17(2)∶187.
- 43. 劉俊， 夏強. 急性重癥胰腺炎早期腸內營養反復失敗1例 [J]. 腸內與腸外營養， 2002； 9（2）∶118.
- 44. 伍曉汀， 張肇達， 趙小菲. 重癥急性胰腺炎的營養支持 [J]. 中國普外基礎與臨床雜志， 2004； 11（3）∶273.
- 45. Whitcomb DC. Clinical practice. Acute pancreatitis [J]. N Engl J Med, 2006; 354(20)∶2142.