重症胰腺炎的营养支持疗法

荆雪; 田字彬

重症胰腺炎的营养支持疗法

荆雪,
田字彬

青岛大学医学院附属医院消化内科

详细信息

中图分类号: R576
计量
- 文章访问数: 4454
- HTML全文浏览量: 11
- PDF下载量: 1258
- 被引次数: 0
出版历程
- 收稿日期: 2011-10-17
- 出版日期: 2011-11-20

Nutritional support therapy in severe acute pancreatitis

摘要

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。
- 胰腺炎 /
- 营养支持
Abstract: Nutrition is a critical aspect in the management of severe acute pancreatitis.This review aims to systematically review the evidence available to report the use of nutritional support treatment in severe acute pancreatitis.Nutritional support therapy is indicated if patients cannot consume normal food after 5-7days of hospital admission or when it becomes evident that the patient will not be able to tolerate oral intake for a prolonged period of time (7 days or more) .EN is preferred over PN, because it reduces complications and mortality in AP.PN is only to be used in patients unable to tolerate EN.It is likely that EN has a beneficial influence on the disease course and should be initiated as early as possible (with 48 hours of admission) .It can be stated that nasogastric tube feeding in SAP is possible.The clinical evidence for the use of just (semi) elemental formulas is weak.Supplementation of enteral formulas with glutamine and prebiotics and the use of immune enhancing formulas cannot routinely be recommended.
- pancreatitis /
- nutritional support

HTML全文

参考文献(34)

[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.

施引文献

资源附件(0)

访问统计