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重症胰腺炎的营养支持疗法

荆雪 田字彬

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重症胰腺炎的营养支持疗法

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  • 中图分类号: R576

Nutritional support therapy in severe acute pancreatitis

  • 摘要: 营养支持疗法在重症急性胰腺炎(SAP)的治疗中有着举足轻重的作用,本文总结近年SAP营养支持疗法方面的热点及新观点。SAP患者入院后5~7 d不能经口进食的患者应开始营养支持。营养支持疗法中肠内营养(EN)较肠外营养(PN)能减少并发症及病死率,EN优于PN。在48 h内开展EN对SAP的转归有积极的作用。新近研究表明SAP患者使用鼻胃管营养途径(NG)是可行的,但目前尚有争议。目前半要素或要素型EN营养制剂的使用经验和临床研究还是不充分的,谷氨酰胺、促动力药、免疫增强型EN营养制剂及益生菌不作为常规推荐。

     

  • [1]Davies AR, Morrison SS, Ridley EJ, et al.Nutritional therapyin patients with acute pancreatitis requiring critical care unitmanagement:A prospective observational study in Australiaand New Zealand[J].Crit Care Med, 2011, 39 (3) :462-468.
    [2]中华医学会.重症急性胰腺炎内科规范治疗建议[J].中华消化杂志, 2009, 29 (2) :75-78.
    [3]Dhaliwal R, Madden SM, Cahill N, et al.Guidelines, guide-lines, guidelines:what are we to do with all of these NorthAmerican guidelines?[J].JPEN J Parenter Enteral Nutri, 2010, 34 (6) :625-643.
    [4]Gianotti L, Meier R, Lobo DN, et al.ESPEN Guidelines onParenteral Nutrition:pancreas[J].Clin Nutr, 2009, 28 (4) :428-435.
    [5]American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors.Clinical Guidelines for the Useof Parenteral and Enteral Nutrition in Adult and Pediatric Pa-tients, 2009[J].JPEN J Parenter Enter Nutr, 2009, 33 (3) :255-259.
    [6]Cangelosi MJ, Auerbach HR, Cohen JT.A clinical and eco-nomic evaluation of enteral nutrition[J].Current medical re-search and opinion, 2011, 27 (2) :413-422.
    [7]Vieira JP, Araujo GF, Azevedo JR, et al.Parenteral nutritionversus enteral nutrition in severe acute pancreatitis[J].Actacirurgica brasileira/Sociedade Brasileira para Desenvolvim-ento Pesquisa em Cirurgia, 2010, 25 (5) :449-454.
    [8]Petrov MS, Whelan K.Comparison of complications attribut-able to enteral and parenteral nutrition in predicted severe a-cute pancreatitis:a systematic review and meta-analysis[J].Br J Nutr, 2010, 103 (9) :1287-1295.
    [9]Sharifi MN, Walton A, Chakrabarty G, et al.Nutrition sup-port in intensive care units in England:a snapshot of presentpractice[J].Br J Nutr, 2011 (31) :1-5.[Epub ahead ofprint]
    [10]Casaer MP, Mesotten D, Hermans G, et al.Early versuslate parenteral nutrition in critically ill adults[J].N Engl Jmed, 2011, 365 (6) :506-517.
    [11]Oláh A, Romics LJ.Evidence-based use of enteral nutritionin acute pancreatitis[J].Langenbecks Arch surg, 2010, 395 (4) :309-316.
    [12]Hegazi R, Raina A, Graham T, et al.Early jejunal feeding ini-tiation and clinical outcomes in patients with severe acutepancreatitis[J].JPEN J Parenter Enter Nutr, 2011, 35 (1) :91-96.
    [13]Welpe P, Frutiger A, Vanek P, et al.Jejunal feeding tubescan be efficiently and independently placed by intensive careunit teams[J].JPEN J Parenter Enter Nutr, 2010, 34 (2) :121-124.
    [14]Gerlach AT, Murphy C.An update on nutrition support in thecritically ill[J].J Pharm Pract, 2011, 24 (1) :70-77.
    [15]Fang JC, Delegge MH.Enteral feeding in the critically ill:therole of the gastroenterologist[J].Am J Gastroenterol, 2011, 106 (6) :1032-1037;quiz 1038.
    [16]Bakker OJ, Van Santvoort HC, Van Brunschot S, et al.Pan-creatitis, very early compared with normal start of enteralfeeding (PYTHON trial) :design and rationale of a random-ised controlled multicenter trial[J].Trials, 2011, 12:73.
    [17]Doig GS, Heighes PT, Simpson F, et al.Early enteral nutri-tion, provided within 24 h of injury or intensive care unit ad-mission, significantly reduces mortality in critically ill pa-tients:a meta-analysis of randomised controlled trials[J].Intensive Care Med, 2009, 35 (12) :2018-2027.
    [18]Singer P, Anbar R, Cohen J et al.The tight calorie controlstudy (TICACOS) :a prospective, randomized, controlled pi-lot study of nutritional support in critically ill patients[J].In-tensive Care Med, 2011, 37 (4) :601-609.
    [19]Spanier BW, Bruno MJ, Mathus-Vliegen EM.Enteral Nu-trition and Acute Pancreatitis:A Review[J].GastroenterolRes Practi, 2011, 2011:1-9.
    [20]Petrov MS, Loveday BP, Pylypchuk RD, et al.Systematicreview and meta-analysis of enteral nutrition formulations inacute pancreatitis[J].Br surg, 2009, 96 (11) :1243-1252.
    [21]Zou XP, Chen M, Wei W, et al.Effects of enteral immunonutri-tion on the maintenance of gut barrier function and immunefunction in pigs with severe acute pancreatitis[J].JPEN J Par-enter Enter Nutr, 2010, 34 (5) :554-566.
    [22]Marik PE, Zaloga GP.Immunonutrition in critically ill patients:asystematic review and analysis of the literature[J].Intensivecare med, 2008, 34 (11) :1980-1990.
    [23]Andrews PJ, Avenell A, Noble DW, et al.Randomised trialof glutamine, selenium, or both, to supplement parenteralnutrition for critically ill patients[J].BMJ, 2011, 342:d1542.
    [24]Lasztity N, Hamvas J, BiróL, et al.Effect of enterally ad-ministered n-3 polyunsaturated fatty acids in acute pancrea-titis-a prospective randomized clinical trial[J].Clin Nutr, 2005, 24 (2) :198-205.
    [25]Sukhotnik I, Shany A, Bashenko Y, et al.Parenteral but notenteral omega-3 fatty acids (Omegaven) modulate intesti-nal regrowth after massive small bowel resection in rats[J].JPEN J Parenter Enter Nutr, 2010, 34 (5) :503-512.
    [26]Wang X, Li W, Zhang F, et al.Fish oil-supplemented par-enteral nutrition in severe acute pancreatitis patients andeffects on immune function and infectious risk:a randomizedcontrolled trial[J].Inflammation, 2009, 32 (5) :304-309.
    [27]Ol'ah A, Bel'agyi T, Issekutz A, et al.Randomized clinical tri-al of specific lactobacillus and fibre supplement to early enter-al nutrition in patients with acute pancreatitis[J].Br J Surg, 2002, 89 (9) :1103-1107.
    [28]Ol'ah A, Bel'agyi T, P'ot'o L, et al.Synbiotic control of inflammation and infection in severe acute pancreatitis:a prospec-tive, randomized, double blind study[J].Hepatogastroen-terology, 2007, 54 (74) :590-594.
    [29]Zhong Y, Cai D, Cai W, et al.Protective effect of galactooli-gosaccharide-supplemented enteral nutrition on intestinalbarrier function in rats with severe acute pancreatitis[J].Clin Nutr, 2009, 28 (5) :575-580.
    [30]Talukdar R, Swaroop Vege S.Early management of severeacute pancreatitis[J].Curr Gastroenterol Rep, 2011, 13 (2) :123-130.
    [31]Besselink MG, Van Santvoort HC, RENOOIJ W et al.Intesti-nal barrier dysfunction in a randomized trial of a specific probi-otic composition in acute pancreatitis[J].Ann surg, 2009, 250 (5) :712-719.
    [32]Maclaren R, Kiser TH, Fish DN, et al.Erythromycin vs me-toclopramide for facilitating gastric emptying and tolerance tointragastric nutrition in critically ill patients[J].JPEN J Paren-ter Enter Nutr, 2008, 32 (4) :412-419.
    [33]Nguyen NQ, Chapman MJ, Fraser RJ, et al.Erythromycin ismore effective than metoclopramide in the treatment of feedintolerance in critical illness[J].Crit Care Med, 2007, 35 (2) :483-489.
    [34]Al Samaraee A, Mccallum IJ, Coyne PE, et al.Nutritionalstrategies in severe acute pancreatitis:a systematic reviewof the evidence[J].Surgeon, 2010, 8 (2) :105-110.
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  • 收稿日期:  2011-10-17
  • 出版日期:  2011-11-20
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