重症急性胰腺炎的临床营养支持治疗

重症急性胰腺炎(SAP)常出现代谢紊乱及肠道功能紊乱,严重感染和多脏器功能障碍综合征(MODS)是主要死因。在SAP病程的不同时期采取不同的营养(肠内及肠外营养)支持单独或者联合应用可以改善患者的营养状况,维护肠道黏膜屏障及机体免疫功能,避免或减轻炎性细胞因子的过量释放和瀑布样级联反应(cascade)造成的全身炎性反应综合征(SIRS)和MODS,从而显著降低SAP的感染率和病死率。因肠外营养易发生导管相关性感染及“过度营养”的问题,故强调早期放置鼻空肠管到Treitz韧带下方进行肠内免疫营养支持是安全有效的。

Nutritional Support in Acute Pancreatics

The patents with SAP often has matabolic disturbance and intestinal tract functional disturbance,severe infection and MODS are its main death cause.During the different stages of SAP,the application of different nutritional(enteral and parenteral alimentation)support,used either independent or comibined may improve the nutriture of the patients,maintain the intestinal tract mucosa barriers and immunopotency of the organism and avoid or relieve excessive release of inflammatory cell factors as well as SIRS and MODS caused by cascade,then greatly reduce SAP infecion rate and case fatality rate.As parenteral alimentation may easily cause ductus-related infection and "excessive nutrition",it should be emphasized that it is safe and effective to put nasojejunal tube below Treitz ligament in the early stage to gain enteral nutritional support.