重症急性胰腺炎的早期营养支持治疗

荆雪; 田字彬

doi:10.3969/j.issn.1001-5256.2017.01.007

重症急性胰腺炎的早期营养支持治疗

DOI: 10.3969/j.issn.1001-5256.2017.01.007

荆雪,
田字彬

青岛大学附属医院消化内科

详细信息

中图分类号: R576
计量
- 文章访问数: 2786
- HTML全文浏览量: 47
- PDF下载量: 592
- 被引次数: 0
出版历程
- 收稿日期: 2016-09-30
- 出版日期: 2017-01-20

Early nutrition support therapy for patients with severe acute pancreatitis

Department of Gastroenterology,The Affiliated Hospital of Qingdao University

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。总结了近年来SAP营养支持疗法方面的热点及新观点。肠黏膜屏障的损伤在胰腺炎的进展中发挥重要作用,肠内营养可保护肠黏膜屏障的功能,早期肠内营养可以明显降低患者病死率及并发症的发生率。SAP患者采用经鼻胃管途径进行营养支持,同鼻空肠管途径一样安全、有效。目前半要素或要素型肠内营养制剂的使用经验和临床研究尚不充分,免疫增强型肠内营养制剂及益生菌不作为常规推荐。
- 胰腺炎 /
- 营养支持 /
- 治疗
Abstract: Nutrition support therapy plays an important role in the treatment of severe acute pancreatitis( SAP). This article reviews the hot topics and new ideas in nutrition support therapy for SAP in recent years. Damage of intestinal mucosal barrier plays an important role in the progression of pancreatitis. Enteral nutrition can protect the function of intestinal mucosal barrier and early enteral nutrition can significantly reduce patients' mortality rate and incidence rate of complications. Nutrition support for SAP patients via a nasogastric tube has comparable safety and effect to the nutrition support via a nasojejunal tube. At present,there are no enough experience and clinical studies on semi- elemental or elemental enteral nutrition preparations,and immune- enhancing enteral nutrition preparations and probiotics are not recommended as conventional means.
- pancreatitis /
- nutritional support /
- therapy

HTML全文

参考文献(27)

[1]NAKAJIMA T,UEDA T,TAKEYAMA Y,et al.Protective effects of vascular endothelial growth factor on intestinal epithelial apoptosis and bacterial translocation in experimental severe acute pancreatitis[J].Pancreas,2007,34(4):410-416.

[2]FLINT RS,PHILLIPS AR,POWER SE,et al.Acute pancreatitis severity is exacerbated by intestinal ischemia-reperfusion conditioned mesenteric lymph[J].Surgery,2008,143(3):404-413.

[3]GUO ZZ,WANG P,YI ZH,et al.The crosstalk between gut inflammation and gastrointestinal disorders during acute pancreatitis[J].Curr Pharm Des,2014,20(7):1051-1062.

[4]GLOVER LE,LEE JS,COLGAN SP.Oxygen metabolism and barrier regulation in the intestinal mucosa[J].J Clin Invest,2016,126(10):3680-3688.

[5]FENG CG,SCANGA CA,COLLAZO-CUSTODIO CM,et al.Mice lacking myeloid differentiation factor 88 display profound defects in host resistance and immune responses to Mycobacterium avium infection not exhibited by Toll-like receptor 2(TLR2)-and TLR4-deficient animals[J].J Immunol,2003,171(9):4758-4764.

[6]WANG R,YANG F,WU H,et al.High-dose versus low-dose octreotide in the treatment of acute pancreatitis:a randomized controlled trial[J].Peptides,2013,40:57-64.

[7]JAWOREK J,SZKLARCZYK J,BONIOR J,et al.Melatonin metabolite,N(1)-acetyl-N(1)-formyl-5-methoxykynuramine(AFMK),attenuates acute pancreatitis in the rat:in vivo and in vitro studies[J].J Physiol Pharmacol,2016,67(3):411-421.

[8]SEMENOV DIU,OSMANOV ZKH,TONOIAN AG,et al.Results of dynamic assessment of melatonin receptor expression in lymphocytes in patients with acute mild and severe pancreatitis[J].Vestn Khir Im I I Grek,2014,173(1):44-46.

[9]FAN H,WU H,TAN QH,et al.Relevance of intestinal mucosal barrier damage and alteration of luminal microflora after intestinal ischemia reperfusion injury in macaque[J].Chin J Gastroenteral,2006,11(5):268-272.(in Chinese)范华,吴浩,谭庆华,等.猕猴肠缺血再灌注后肠道菌群变化与肠黏膜屏障损伤的关系[J].胃肠病学,2006,11(5):268-272.

[10]CHEN P,HU B,TAN Q,et al.Role of neurocrine somatostatin on sphincter of Oddi contractility and intestinal ischemia reperfusion-induced acute pancreatitis in macaques[J].Neurogastroenterol Motil,2010,22(8):935-941,e240.

[11]GUZY C,SCHIRBEL A,PACLIK D,et al.Enteral and parenteral nutrition distinctively modulate intestinal permeability and T cell function in vitro[J].Eur J Nutr,2009,48(1):12-21.

[12]LI X,MA F,JIA K.Early enteral nutrition within 24 hours or between 24 and 72 hours for acute pancreatitis:evidence based on 12RCTs[J].Med Sci Monit,2014,20:2327-2335.

[13]PENG L,WU LG,LI B,et al.Early enteral nutrition improves intestinal immune barrier in a rat model of severe acute pancreatitis[J].J Hepatobiliary Pancreat Sci,2016,23(11):681-687.

[14]QIAO SF,LU TJ,SUN JB,et al.Alterations of intestinal immune function and regulatory effects of L-arginine in experimental severe acute pancreatitis rats[J].World J Gastroenterol,2005,11(39):6216-6218.

[15]LI JY,YU T,CHEN GC,et al.Enteral nutrition within 48 hours of admission improves clinical outcomes of acute pancreatitis by reducing complications:a meta-analysis[J].PLo S One,2013,8(6):e64926.

[16]YI F,GE L,ZHAO J,et al.Meta-analysis:total parenteral nutrition versus total enteral nutrition in predicted severe acute pancreatitis[J].Intern Med,2012,51(6):523-530.

[17]BAKKER OJ,van BRUNSCHOT S,FARRE A,et al.Timing of enteral nutrition in acute pancreatitis:meta-analysis of individuals using a single-arm of randomised trials[J].Pancreatology,2014,14(5):340-346.

[18]STIMAC D,POROPAT G,HAUSER G,et al.Early nasojejunal tube feeding versus nil-by-mouth in acute pancreatitis:a randomized clinical trial[J].Pancreatology,2016,16(4):523-528.

[19]ZHAO XL,ZHU SF,XUE GJ,et al.Early oral refeeding based on hunger in moderate and severe acute pancreatitis:a prospective controlled,randomized clinical trial[J].Nutrition,2015,31(1):171-175.

[20]ZHU Y,YIN H,ZHANG R,et al.Nasogastric nutrition versus nasojejunal nutrition in patients with severe acute pancreatitis:a meta-analysis of randomized controlled trials[J].Gastroenterol Res Pract,2016,2016:6430632.

[21]PETROV MS,LOVEDAY BP,PYLYPCHUK RD,et al.Systematic review and meta-analysis of enteral nutrition formulations in acute pancreatitis[J].Br J Surg,2009,96(11):1243-1252.

[22]HAN T,LI XL,CAI DL,et al.Effects of glutamine-supplemented enteral or parenteral nutrition on apoptosis of intestinal mucosal cells in rats with severe acute pancreatitis[J].Eur Rev Med Pharmacol Sci,2013,17(11):1529-1535.

[23]DHALIWAL R,MADDEN SM,CAHILL N,et al.Guidelines,guidelines,guidelines:what are we to do with all of these North American guidelines?[J].JPEN J Parenter Enteral Nutr,2010,34(6):625-643.

[24]SUKHOTNIK I,SHANY A,BASHENKO Y,et al.Parenteral but not enteral omega-3 fatty acids(Omegaven)modulate intestinal regrowth after massive small bowel resection in rats[J].JPEN J Parenter Enteral Nutr,2010,34(5):503-512.

[25]ANDREWS PJ,AVENELL A,NOBLE DW,et al.Randomised trial of glutamine,selenium,or both,to supplement parenteral nutrition for critically ill patients[J].BMJ,2011,342:d1542.

[26]van BAAL MC,van RENS MJ,GEVEN CB,et al.Association between probiotics and enteral nutrition in an experimental acute pancreatitis model in rats[J].Pancreatology,2014,14(6):470-477.

[27]POROPAT G,GILJACA V,HAUSER G,et al.Enteral nutrition formulations for acute pancreatitis[J].Cochrane Database Syst Rev,2015,(3):CD010605.

施引文献

资源附件(0)

访问统计