Enteral versus parenteral nutritional support in acute pancreatitis: A clinical review

Abstract   A critical analysis of the trials comparing enteral with parenteral nutritional support in acute pancreatitis is presented with particular scrutiny of the clinical endpoints in each trial. The heterogeneity of the trials and the discrepancies in caloric intake between enterally and parenterally fed patients are discussed. The hazards of each route of nutritional support are highlighted and the concept of 'nutritional bioavailability' in the context of acute pancreatitis is introduced. It is concluded that although there is evidence to support enteral feeding as the preferred option, both routes have a role.     

重型病毒性肝炎合并急性胰腺炎的临床分析

目的通过对重型病毒性肝炎合并急性胰腺炎的病例进行分析,以找出其临床特点.方法对上述病例的临床症状、实验室检查、治疗情况、病情的发生发展及预后进行分析.结果少数患者表现不典型或胰腺炎的症状被重型肝炎的严重症状所掩盖,容易发生漏诊及误诊;且病情发展快、预后差.结论只有对相应患者尽早做血、尿淀粉酶的测定并反复复查,才能做到及时诊断和治疗.     

早期肠内营养及其输注方式对大鼠重症急性胰腺炎病理和肠道功能的影响

目的:观察早期肠内营养及其不同输注方式对重症急性胰腺炎的影响。方法:采用胰管逆行注射建立大鼠重症急性胰腺炎(SAP)模型,假手术组用生理盐水,SAP组随机分为持续、间隙和未行肠内营养3个亚组(每组12只),假手术组同样分为3个亚组(每组8只)。各组于48 h后启动肠内营养,72 h后再次麻醉大鼠,收集组织及血液标本;检测指标包括肠道转运系数、血淀粉酶、器官细菌移位率、血清细胞因子TNF-α、胰腺病理评分及血浆D-乳酸等。结果:①、SAP后48h进行肠内营养并未加重胰腺炎;肠内营养组与未行肠内营养组在血淀粉酶、胰腺病理评分方面,差异无统计学意义(P>0.05);然而早期肠内营养可以促进肠蠕动,减少肠道细菌移位率,两组间在肠道转运系数、脏器细菌移位率及血清TNF-α水平方面,差异有统计学意义(P<0.05)。②、SAP行肠内营养的两种方式间,各项指标比较无显著差异。结论:SAP大鼠在早期行肠内营养是可行的,其可保持肠道生理的完整性、减少了脏器细菌移位率,但未改善预后;持续和间隙二种肠内营养输注方式间无显著差异。     

重症急性胰腺炎大鼠肺组织中LIF的表达变化及意义

目的:观察重症急性胰腺炎(SAP)大鼠白血病抑制因子(LIF)在肺组织中表达的时相变化, 探讨LIF在SAP病程及肺损伤中的意义．方法:36只♂SD大鼠随机分为正常对照组(N 组,n=6)、假手术组(Sham组,n=6)和重症急性胰腺炎组(SAP组,n=24)．采用胰管逆行灌注50 g/L牛磺胆酸钠的方法复制大鼠SAP模型．用RT-PCR法检测肺组织中LIF mRNA的表达水平,免疫组织化学方法检测NLIF在肺组织中的表达变化．结果:SAP组3 h后肺组织LIF mRNA的表达量明显高于对照组和假手术组(灰度值:1．018± 0．065 vs 1．451±0．067,1．322±0．072,P<0,05), 并且6,12,24 h持续升高(0．853±0．058,0．635 ±0．064,0．582±0．089)(P<0．01)．同样,SAP组 LIF蛋白表达在3和6 h后明显高于对照组和假手术(127．36±2．76,122．53±2．43 vs 159．46 ±2．78,156．35±3．12,P<0．05),并且12,24 h后也维持在很高的水平(109．37±2．87,102．42± 2．27)．结论:LIF作为促炎症因子参与了SAP肺组织的炎症反应．     

Risk of death from acute pancreatitis

Summary Conclusions The analysis of all the data available in 192 patients at 24 h from admission shows that only serum glucose above 250 mg/dL (13.88 mmol/L) and serum creatinine above 2 mg/dL (176.8 μmol/L) are prognostic factors of death (P<0.0001). When, however, pathological chest X-rays are also considered in a subset of 149 patients, these and serum creatinine are prognostic factors of death with odds ratios of 2.9 (95% CL 1.3–6.3) and 9.4 (95% CL 2.2–40.7), respectively (P<0.0001). Background In patients suffering from acute pancreatitis, neither Ranson scores nor Glasgow criteria evaluation at 24 h yield a sufficiently reliable prognosis of the risk of death from the first acute attack. Methods After excluding posttraumatic, postsurgical, and post-ERCP acute pancreatitis, we selected 192 consecutive patients admitted in the first instance to our center for a first attack, distinguishing between patients who died and patients who survived. We used Cox's model to analyze the prognostic weight of variables available within 24 h of admission (sex, age, alcohol intake, smoking habits, 17 biochemical tests, body mass index, chest X-rays, body temperature, and shock status). Results Seventeen (8.8%) patients died; mortality showed a decreasing trend over the period of years considered and was correlated, among other things, with necrotizing type of pancreatitis, idiopathic etiology, and shock status on admission.     

Medical management of chronic pancreatitis

慢性胰腺炎的临床表现包括疼痛、脂肪泻和糖尿病。在西方国家，慢性胰腺炎最常见的病因是酗酒。70％以上的病人在就诊时有疼痛的临床表现，而且，这些患者中又有75％以上会在几年之后出现疼痛减轻或完全消失。对于所有的慢性胰腺炎的病人来说，均应排除非胰源性疼痛和胆道梗阻、胰腺假性囊肿等胰腺局部并发症。应建议所有慢性胰腺炎病人戒烟、戒酒。阿片类镇痛剂仅应用于治疗疼痛严重的病人。尽管有报道认为胰酶替代治疗有助于止痛，但是，对于已经确诊的慢性胰腺炎病人来说，该疗法无效。激素类药物进行腹腔神经丛阻滞术可能有助于病人度过剧烈疼痛期。顽固性疼痛是进行胰液引流或胰腺切除的适应证。建议应用适量胰酶替代联合(或不联合)制酸剂治疗营养不良。慢性胰腺炎导致的糖尿病与原发性糖尿病的治疗原则相似。     

脂肪乳剂在重症急性胰腺炎营养治疗中的安全性及有效性分析

目的 :探讨脂肪乳剂应用于重症急性胰腺炎的安全性和有效性。　方法 :回顾分析重症急性胰腺炎病人肠外营养治疗期间 ,应用脂肪乳剂的影响。 74例重症急性胰腺炎病人行肠外营养治疗 ,按静脉营养液是否含脂肪乳剂分为脂乳组和非脂乳组。　结果 :脂乳组肠外营养治疗后清蛋白、前白蛋白改善显著 (P <0 .0 1 ) ,非脂乳组则无显著变化 (P >0 .0 5 ) ,脂乳组较非脂乳组改善明显 (P <0 .0 1 ) ;血清肌酐、尿素氮等在脂乳组治疗后下降明显 (P <0 .0 5 ) ,较非脂乳组改善显著 (P <0 .0 5 ) ;营养治疗结束后 ,脂乳组高血糖症状明显得到控制 (P <0 .0 1 ) ,而非脂乳组效果不佳 (P >0 .0 5 ) ,脂乳组优于非脂乳组 (P <0 .0 5 ) ;血淀粉酶均有下降 ,脂乳组未见异常增高。　结论 :重症急性胰腺炎病人输注脂肪乳剂安全有效 ,有助于恢复正氮平衡     

Hepatic infarction with portal thrombosis

A case of hepatic infarction with portal thrombosis is reported. A 63-year-old woman with liver cirrhosis and esophageal varices was admitted for treatment of the esophagel varices. Endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy (EIS) were performed. Two months later, she experienced right hypochondralgia and right flank pain. Serum transaminase levels were suddenly elevated, and computed tomography scans of the liver showed multiple small nodular lesions. Her condition worsened, and she died of hepatic failure. Autopsy revealed splenic and portal vein thrombosis, multiple hepatic infarction, and evidence of chronic pancreatitis. We believe that liver cirrhosis and chronic pancreatitis were the main risk factors for the portal thrombosis, and the treatment for esophageal varices appeared to have triggered the thrombosis. The hepatic infarction was caused by the portal thrombosis.