急性胰腺炎行全肠外营养所致肝胆并发症的临床观察（附17例分析）

目的：了解急性胰腺炎全肠外营养支持包致肝胆并发症的发生情况。方法：对我院1995年1月－2000年12月收治的符合纳入标准的17例急性胰腺炎，进行血清酶（GGT、ALP、ALT、AST），胆红素（TB、DB）、白蛋白（Alb)的动态定量分析，B型超声的动态定性分析，以及并发症（黄疸、感染等）和预后的观察。结果：17例患者中血清酶分别在发病初期和疾病后期出现两次高峰期，血清胆红素水平有随病情进展而降低的趋势，血清白蛋白则先降低后随病情好转而恢复正常，17例患者中发生胆汁淤积7例，感染4例，无肉眼黄疸及死亡发生。结论：急性胰腺炎本身可以在早期引起肝功能损害，随病情好转而恢复；但当急性胰腺炎病期延长，全肠外营养支持所致肝胆并发症的发生则不容忽视，急需早期预防和诊治，提倡尽可能早期行肠内营养支持。

The Clinical Observation of Hepatobiliary Complications Associated with Total Parenteral Nutrition in Acute Pancreatitis (A Report of 17 Cases)

Objective:To observe the occurrence of hepatobiliary complications associated with total parenteral nutrition(TP)in acute pancreatitis(AP).Method:Seventeen cases suffering from AP admitted in our hospital between Jan,1995 and Dec,2000.Dynamic quantitative analysis of serum enzyme(GGT,ALP,ALT,AST),bilirubin(TB,OB)and albumin(Alb),and dynamic qualitative analysis of B-ultrasonic were made.Also the complications(jaundice,infection etc.)and prognosis were observed.Results:(1)Two peaks of serum enzyme were observed at the early and later stage,respectively;(2)Serum bilirubin descended with the progression of the disease;(3)Serum albumin restored normal following a transient drop;(4)In 17 cases,7cases suffering from cholestasis,4 cases from infection,and no jaundice or death were developed in all cases.Conclusions:Hepatic impairment attributed to AP could recover with the rehabilitation.But accompanying the prolonged course of the disease,great attontion should be paid to the occarrence of hepatobiliary complications associated with TP.Prevention and management were essential and enteral nutritionin should be in initialed as early in the initial stage.