重症急性胰腺炎肠内营养治疗的效果观察

目的:研究肠内营养(EN)支持治疗重症急性胰腺炎(SAP)的效果.方法:将40例SAP患者随机分为EN支持治疗组20例和全胃肠外营养(TPN)支持治疗组20例.比较两组间血清C反应蛋白、前白蛋白、白蛋白水平,以及采取外科手术治疗率、感染率、死亡率和ICU治疗时间、住院时间的差异.结果:两组在营养支持治疗后第14天的血清C反应蛋白水平均较营养支持治疗前明显下降(P<0.05),前白蛋白均明显升高(P<0.05);在第14天血清白蛋白水平在EN组较营养支持治疗前轻度升高[(32.35±3.07)g/L 比(36.87±2.38)g/L,P<0.05],TPN组无明显差异[(33.09±5.39)g/L 比 (35.20±3.41)g/L,P>0.05];两组间的手术治疗率(45% 比 55%,P>0.05),死亡率(8.1% 比7.5%,P>0.05)和ICU治疗时间[平均11.5d(7～21d)比平均14.1d(5～20d),P>0.05]无明显的差异;相对于TPN组,EN组可减少感染率(35% 比60%,P<0.05)并且缩短了住院时间[平均28.3d(18～92d)比平均38.7d(15～77d),P<0.05].结论:EN能减少感染的发生并且缩短住院时间,疗效较好.     

重症急性胰腺炎的营养支持治疗

目的 研究不同营养途径对重症急性胰腺炎(SAP)病人营养及预后的影响.方法 回顾性分析42例SAP病人,分为早期肠内营养(EEN组,n=21)及完全肠外营养(TPN组,n=21).EEN组在入院后3～6 d均通过空肠营养管输注百普素(Pepti-2000variant),两组予等热量、等氮量,总热量30 kcal/kg·d,氮量为0.17 g/kg·d.结果 ①EEN组死亡率低于TPN组,但无显著性差异(P＞0.05),EEN组住院天数明显少于TPN组(P＜0.01);②入院后2周:EEN组血红蛋白、体重高于TPN组,但无显著性差异;血浆总蛋白、白蛋白高于TPN组(P＜0.05);前白蛋白明显高于TPN组(P＜0.01).结论 与TPN支持相对比,EEN可有效地改善SAP病人的营养状态,缩短住院时间.     

重症急性胰腺炎的营养治疗

重症急性胰腺炎(severe acute pancreatitis,SAP)为临床常见的急危重症,是临床治疗的重点及难点,近年来随着对其病理生理的认识及器官支持水平的提高,其并发症率及病死率已明显下降,但据报道病死率仍高达30%.对其治疗除了早期的容量复苏及器官支持治疗外,营养治疗对其预后有重要的意义,以下就目前营养治疗的有关问题进行讨论.     

重症急性胰腺炎的营养支持

重症急性胰腺炎 (severe acute pancreatitis,SAP)常可导致病人代谢紊乱 ,营养障碍 ,进一步使病情恶化 ,增加病死率。其病情严重程度与营养不良的程度密切相关 [1 ] ,所以在其整个病程中 ,合理营养支持是十分重要的。我院 1985年 1月至 1999年 6月采用营养支持治疗 SAP36例 ,效果满意 ,现报告如下。临床资料一、一般资料 :本组男 15例 ,女 2 1例 ,年龄 16～ 6 8岁 ,平均 47岁。依据中华医学会胰腺外科学组 1996年提出的 SAP临床诊断及分级标准 [2 ] ,属 级 2 4例 (6 6 .6 7% ) , 级 12例 (33.33% )。1995年以前均行手术治疗和 1995年以…     

肠内外营养支持治疗重症急性胰腺炎的临床对比分析

目的 对比肠内外营养支持方式对重症急性胰腺炎(SAP)患者的治疗作用,阐明肠内营养的优点.方法 59例SAP患者,分为全胃肠外营养(TPN)组24例及肠内营养(EN)组35例,分别检测分析两组的营养学指标,对比观察两组的治疗效果.结果 两组血清白蛋白、前白蛋白、转铁蛋白、血红蛋白治疗后与治疗前相比,均有改善(P<0.05);血清前白蛋白、转铁蛋白EN组与TPN组比较,差异有统计学意义(P<0.05).无论治疗后1周还是治疗后2周,APACHE Ⅱ评分EN组均低于TPN组(P<0.05).EN组的胰腺胰周感染率、其他并发症发病率、经口进食时间及治疗费用均低于TPN组(P<0.05),虽然病死率、住院天数两组间无统计学差异(P>0.05). 结论 EN可以改善SAP患者的营养状况,且具有保护肠黏膜屏障功能,减少细菌及毒素移位,调节炎症和感染反应,降低医疗费用等优点,是治疗SAP理想的营养支持方式.     

重症急性胰腺炎营养支持治疗研究进展

重症急性胰腺炎（SAP）导致许多炎症和营养障碍,SAP患者营养风险都很高。适当的营养治疗可以显著降低SAP患者的感染并发症发生率和死亡率。早期（24～48 h内开始）肠内营养（EN）是大多数患者的最佳选择,可减轻继发于胰腺炎症的胃肠运动障碍,从而保护肠道屏障功能。目前,肠外营养（PN）在SAP患者中的应用仅限于EN不可能或禁忌的情况。本文综述了SAP患者早期与延迟EN、鼻胃管与鼻空肠管EN、EN与PN以及免疫营养在SAP患者中的作用进展。     

重症急性胰腺炎的营养支持

重症急性胰腺炎(SAP)约占所有急性胰腺炎(AP)的15％～20％左右，是指具有明显腹膜炎体征和(或)伴有器官功能障碍者．胰腺及胰周多有坏死，病死率为20％～60％。近年来，SAP的治疗多以非手术治疗为主，重点是脏器功能维护、液体复苏、纠正内稳态失调、抑制胰腺外分泌和预防胰腺坏死合并感染。只有在胰腺坏死合并感染时，才考虑手术     

重症急性胰腺炎的早期营养支持治疗

营养支持包括肠外营养和肠内营养 ,是重症急性胰腺炎 (Severeacutepancreatitis ,SAP)的重要临床治疗手段。其治疗的临床价值已经得到肯定 ,但具体实施的方法和方案并不统一。原则上是根据疾病的临床过程制定相应的营养支持方案 ,这已经成为共识。在疾病的早期 ,特别是在 2周以内是疾病病程中最重要的阶段 ,包括循环紊乱期 (72h内 )和全身急性反应期。病初时的主要表现是急腹症和循环血容量不足。此时的胰腺及胰周炎症病变导致大量胰酶渗出 ,其结果是腹膜后犹如一严重的“化学性烧伤区” ,加之其诱发的肠麻痹 ,使大量液体丢失 ,导致循环血…     

肠内营养对重症急性胰腺炎的治疗作用

目的探讨肠内营养在重症急性胰腺炎(SAP)非手术治疗中的作用和疗效。方法对36例SAP患者采用肠内营养支持治疗。结果35例患者空肠内营养平均维持时间19(7~38)d,未出现全身感染或多脏器功能衰竭等严重并发症。1例因假性囊肿形成于第4周行外科手术治疗。结论在SAP非手术治疗期间,适时和尽快由肠外营养过渡到肠内营养,有助于维持肠道屏障功能,改善患者的营养状况,降低感染等并发症的发生,对改善SAP患者的预后有重要意义。     

持续性肾脏替代治疗在急性重度有机磷农药中毒的疗效观察

目的 探讨持续性肾脏替代治疗在急性重度有机磷农药中毒的临床疗效.方法 将急诊科2011年2月至2012年2月住院的急性重度有机磷农药中毒患者21例作为试验组,在常规治疗的基础上联合持续性肾脏替代治疗,对2009年10月至2011年1月住院的急性重度有机磷农药中毒患者30例作为对照组,采用常规治疗.比较两组患者的昏迷时间,胆碱酯酶活力恢复时间,中间综合征发生率,平均住院时间,治愈率,患者平均存活时间.结果 试验组患者昏迷时间、胆碱酯酶活力恢复时间、平均住院时间与对照组比较明显缩短,中间综合征的发生率降低,治愈率提高,患者平均存活时间延长,差异具有统计学意义(P＜0.05).结论 持续性肾脏替代治疗能明显提高急性重度有机磷中毒的临床疗效.     

连续性肾脏替代与间歇性血液透析治疗急性肾功能衰竭的生存率分析

目的 探讨连续性肾脏替代与间歇性血液透析治疗急性肾功能衰竭的生存率分析.方法 按照纳入标准搜集国内运用连续性肾脏替代和间歇性血液透析对比治疗急性肾功能衰竭的文献.使用Rev Man 5.0统计软件完成Meta分析,以SAS 8.0软件计算失安全系数.结果 按照纳入标准及排除标准,最后纳入6篇文献,包括受试患者476例进...     

Prognosis of severe drug-induced acute interstitial nephritis requiring renal replacement therapy

ObjectiveDrug-induced acute interstitial nephritis (DAIN) is often associated with improved outcomes, whereas some patients may still progress to chronic kidney disease (CKD). The aim of this study was to evaluate the prognosis of patients with severe DAIN requiring renal replacement therapy (RRT) at baseline, and to explore the risk factors of progression to CKD.MethodsWe performed a retrospective study of patients with severe DAIN confirmed by renal biopsies in our center over a 10 years period, all the patients received RRT at presentation. The clinical and pathological characteristics at baseline were recorded, and the outcomes (renal function recovered or progressed to CKD) during follow-ups were also evaluated. Univariate and multivariate logistic regression analysis were performed to identify the independent risk factors of progression to CKD.ResultsSeventy-two patients who met the inclusion criteria were enrolled, 13 patients (18.0%) progressed to CKD (GFR < 60 ml/min/1.73 m²) after at least 6 months of follow-up, the remaining 59 patients achieved a favorable renal function recovery. Compared with patients who achieved renal function recovery (recovery group), the patients progressed to CKD (progression group) were older and had longer interval from symptom onset to treatment with steroids. The peak serum cystatin C concentration was higher in progression group than recovery group. Higher score of interstitial fibrosis/tubular atrophy (IFTA) and more interstitial inflammatory cells infiltration were detected in renal tissue in progression group. According to multivariable analysis, higher peak cystatin C concentration (OR = 2.443, 95% CI 1.257, 4.746, p = 0.008), longer interval to treatment with corticosteroids (OR = 1.183, 95% CI 1.035, 1.352, p = 0.014) were independent risk factors of progression to CKD. The cutoff value of cystatin C concentration was 4.34 mg/L, at which the sensitivity and specificity were 76.9% and 89.3%, respectively; the cutoff value of interval to treatment with corticosteroids was 22.5 days, at which the sensitivity and specificity were 81.8% and 79.5%, respectively.ConclusionRenal function was reversible in majority of patients with severe DAIN requiring RRT when early identification and treatment. Higher peak cystatin C concentration and longer interval to treatment with corticosteroids associated with worse renal prognosis.     

A systematic review of continuous renal replacement therapy and intermittent haemodialysis in management of patients with acute renal failure

Background: Acute renal failure (ARF) still bears a poor prognosis with mortality rates up to 70% and the ideal form of renal replacement therapy (RRT) remains controversial. The purpose of this study was to conduct a systematic review and meta-analysis of all randomized controlled trials (RCT) to examine the effect of dialysis modality (IHD: Intermittent haemodialysis; CRRT: continuous renal replacement therapy) on survival of patients with ARF and to also study the effect of each modality on dialysis dependence (DD). Methods: Using and combining two comprehensive search themes (ARF and RRT), we searched electronic databases from 1969 through September of 2007, supplemented by a manual review of abstracts from nephrology meetings and reference lists of review articles. All RCT comparing IHD with CRRT in adult patients with ARF and with explicit reporting of mortality were included. The primary outcome was the pooled estimate of the odds ratio (OR) of mortality for patients with ARF treated with CRRT versus IHD. The secondary outcome was OR of DD at time of discharge for surviving patients. Results: A total of 587 studies were identified, 554 of which were excluded on initial screening. Analysis of the nine RCT (1635 patients) showed an OR of 0.89 (0.63–1.24) for survival in patients on CRRT. Limiting the analysis to the seven RCT published after the year 2000, revealed an OR of 0.72 (0.58–0.90). The OR of all the studies before 2000 was 1.06 (95% CI 0.67–1.68), as compared with OR of 0.61 (95% CI 0.50–0.74) for studies post-2000. Four studies showed a significantly lower risk of DD among the CRRT group and none showed higher OR for DD. When analysis was limited to the RCT, the OR for DD was 1.07 (0.47–2.39), suggesting no difference in DD between the modalities. Conclusions: Similar to previously reported meta-analyses, we did not find a significant effect of CRRT on the OR of survival. The progressive reduction in the OR of survival with CRRT relative to IHD might reflect progressive improvements in IHD. The OR of DD was not affected by mode of RRT. In conclusion, compared with IHD, CRRT does not offer an advantage with regards to survival or DD in ARF. Considering its cost and potential disadvantages, it is imperative to identify the subset of patients with ARF that would potentially derive maximum benefit from CRRT. This will require large, adequately powered studies with sufficient follow-up.     

连续性肾脏替代疗法联合乌司他丁对重症急性胰腺炎患者凝血功能、炎性因子及免疫屏障功能的影响

目的:探究连续性肾脏替代疗法(continuous renal replacement therapy,CRRT)联合乌司他丁对重症急性胰腺炎(severe acute pancreatitis,SAP)患者凝血功能、炎性因子及免疫屏障功能的影响。方法:选取我院2018年5月至2019年12月期间收治的103例SAP患...     

Continuous renal replacement therapy with a pulsatile tubular pump: parameters must be adjusted in each case

Abstract:  A three-valve, pulsatile tubular pump was used in 24 pigs weighing 10.2 ± 3.2 kg; the pump was connected to a neonatal hemofiltration circuit. Ninety-two periods of 30 min were studied to analyze the efficacy of the system with variations in the percentage time in diastole, the diastolic speed, the systolic speed, and the percentage time in systole during which the postfilter valve was closed. System efficacy was determined by the blood flow through the filter, the ultrafiltrate volume, the vascular overload measured by the inlet aspiration pressure, and the filter overload measured by the cross-filter pressure drop and the transmembrane pressure. The variations in the pump parameters did not lead to significant differences in the efficacy of the system or in the vascular or filter overload. The parameters must be adjusted in each case to obtain the best yield with the lowest vascular and filter overload.     

早期血液滤过治疗重症急性胰腺炎的效果及预后

目的探讨重症急性胰腺炎采用早期血液滤过治疗的临床价值。方法通过前瞻性的随机对照方法的原则,纳入同济医院2011年9月至2015年11月收治的确诊为重症急性胰腺炎病人共100例,所有病例均在发病72 h内接受治疗,采取随机分组方法,对照组采用的是常规对症内科治疗、胃肠减压、灌肠肠内营养、腹腔穿刺引流等方法;早期血液滤过治疗组则在对照组的基础上进行早期血液滤过治疗。分别观察两组病人1周内的急性生理学与慢性健康状况系统Ⅱ(APACHE-Ⅱ)和Balthazar CT评分,同时记录并发症发生率和病死率。结果入院治疗后从第3天开始,早期血液滤过治疗组的APACHE-Ⅱ评分低于对照组,两组差异具有统计学意义;入院后第7天行CT检查Balthazar评分早期血液滤过治疗组低于对照组,两组差异具有统计学意义;早期血液滤过治疗组7 d后并发症和死亡的发生率低于对照组,差异具有统计学意义。结论早期血液滤过治疗可以降低重症急性胰腺炎的并发症及病死率,是治疗重症急性胰腺炎有效方法之一。     

Problems and advantages of continuous renal replacement therapy*

SUMMARY: The continuous replacement of renal function must facilitate fluid and solute homeostasis, nutrition and vital organ function, and, where possible, hasten the recovery of renal function. Difficulties with anticoagulation, biocompatibility, mobility and cost remain obstacles to be overcome. the use of continuous renal replacement therapy (CRRT) to remove systemic inflammatory mediators is yet to be confirmed. Although survival benefits of CRRT over intermittent dialysis remain controversial, the slow continuous removal of fluid, acid and solute has a number of advantages, especially where patients are haemodynamically unstable.