|
|
重症急性胰腺炎的营养支持治疗
|
Abstract:
重症急性胰腺炎(Severe Acute Pancreatitis, SAP)：作为急性胰腺炎的危重类型，死亡率高达10%~30%。全身炎症反应综合征和持续性器官功能衰竭是导致SAP患者死亡或预后不良的关键因素。研究表明，营养支持能够降低全身炎症反应综合征和器官功能障碍的发生几率，改善患者预后，减少感染相关并发症。因此，营养支持治疗在重症急性胰腺炎综合管理中占据重要地位。本文旨在系统阐述SAP营养支持治疗要点。
Severe Acute Pancreatitis (SAP): As a critical type of acute pancreatitis, the mortality rate can reach 10%~30%. Systemic inflammatory response syndrome and persistent organ dysfunction are the key factors leading to death or poor prognosis in SAP patients. Studies have shown that nutritional support can reduce the occurrence rate of systemic inflammatory response syndrome and organ dysfunction, improve the prognosis of patients, and reduce infection-related complications. Therefore, nutritional support therapy occupies an important position in the comprehensive management of severe acute pancreatitis. This article aims to systematically elaborate on the key points of nutritional support therapy for SAP.
| [1] | 左静, 张姝, 李秋桦, 等. 重症急性胰腺炎患者早期肠内营养相关研究的可视化分析[J]. 医学信息, 2024, 37(13): 26-31. |
| [2] | 余剑波, 吴晓炀. 重症急性胰腺炎急性期中西医结合治疗策略[J]. 中国中西医结合外科杂志, 2024, 30(4): 456-461. |
| [3] | 李健雄, 颜建建, 高志强, 等. 重症急性胰腺炎的营养治疗[J]. 宁夏医科大学学报, 2020, 42(1): 100-104. |
| [4] | 阿依江∙加马力丁, 王军红, 马青变. 重症急性胰腺炎肠道菌群变化的研究进展[J]. 中国急救医学, 2021, 41(5): 454-457. |
| [5] | Wang, G., Wen, J., Xu, L., Zhou, S., Gong, M., Wen, P., et al. (2013) Effect of Enteral Nutrition and Ecoimmunonutrition on Bacterial Translocation and Cytokine Production in Patients with Severe Acute Pancreatitis. Journal of Surgical Research, 183, 592-597. https://doi.org/10.1016/j.jss.2012.12.010 |
| [6] | Lakananurak, N. and Gramlich, L. (2020) Nutrition Management in Acute Pancreatitis: Clinical Practice Consideration. World Journal of Clinical Cases, 8, 1561-1573. https://doi.org/10.12998/wjcc.v8.i9.1561 |
| [7] | Huwiler, V.V., Scalise, M., Schönenberger, K.A., Mühlebach, S., Stanga, Z. and Balmer, M.L. (2023) The Role of Dietary Fibre in Enteral Nutrition in Sepsis Prevention and Therapy: A Narrative Review. Nutrients, 15, Article 2489. https://doi.org/10.3390/nu15112489 |
| [8] | Fallis, L.S. (1941) Results of Conservative Treatment of Acute Pancreatitis. Annals of Surgery, 113, 1070. https://doi.org/10.1097/00000658-194106000-00028 |
| [9] | Reintam Blaser, A., Starkopf, J., Alhazzani, W., Berger, M.M., Casaer, M.P., Deane, A.M., et al. (2017) Early Enteral Nutrition in Critically Ill Patients: ESICM Clinical Practice Guidelines. Intensive Care Medicine, 43, 380-398. https://doi.org/10.1007/s00134-016-4665-0 |
| [10] | 田伟华. 肠内及肠外营养支持在重症急性胰腺炎合并肠源性感染患者中的效果分析[J]. 淮海医药, 2022, 40(1): 49-52. |
| [11] | Gupta, R., Patel, K., Calder, P.C., Yaqoob, P., Primrose, J.N. and Johnson, C.D. (2003) A Randomised Clinical Trial to Assess the Effect of Total Enteral and Total Parenteral Nutritional Support on Metabolic, Inflammatory and Oxidative Markers in Patients with Predicted Severe Acute Pancreatitis (APACHEE II ≥ 6). Pancreatology, 3, 406-413. https://doi.org/10.1159/000073657 |
| [12] | 刘远红. 重症急性胰腺炎采用营养支持治疗的临床意义[J]. 中国实用医药, 2021, 16(32): 102-104. |
| [13] | 蔡建平, 周湘鸿, 余海波, 等. 肠外营养对胰十二指肠切除术后患者急性炎症反应和血脂的影响[J]. 中华普通外科杂志, 2020, 35(1): 34-37. |
| [14] | 王金荣, 高攀, 郭淑芬, 等. 重症监护病房补充性肠外营养与医院感染相关性研究[J]. 国际呼吸杂志, 2019, 39(15): 1147-1152. |
| [15] | 曹洁. 重症急性胰腺炎营养治疗的研究进展[J]. 重庆医学, 2020, 49(15): 2583-2587. |
| [16] | 许清涛, 魏航之. 早期肠内营养治疗重症急性胰腺炎的研究进展[J]. 临床合理用药, 2023, 16(24): 173-177. |
| [17] | Cao, Y., Xu, Y., Lu, T., Gao, F. and Mo, Z. (2008) Meta-Analysis of Enteral Nutrition versus Total Parenteral Nutrition in Patients with Severe Acute Pancreatitis. Annals of Nutrition and Metabolism, 53, 268-275. https://doi.org/10.1159/000189382 |
| [18] | 宁爱桦, 尹晶. 不同时机肠内营养对老年重症急性胰腺炎肝损伤影响[J]. 中华胰腺病杂志, 2023, 23(1): 48-51. |
| [19] | 胡腊梅. 重症急性胰腺炎的肠内营养支持治疗效果分析[J]. 世界最新医学信息文摘, 2017, 17(46): 155. |
| [20] | 李维勤, 李宁, 黎介寿. 重症急性胰腺炎病人的营养支持[J]. 肝胆外科杂志, 2003, 11(1): 8-9. |
| [21] | Arvanitakis, M., Ockenga, J., Bezmarevic, M., Gianotti, L., Krznarić, Ž., Lobo, D.N., et al. (2020) ESPEN Guideline on Clinical Nutrition in Acute and Chronic Pancreatitis. Clinical Nutrition, 39, 612-631. https://doi.org/10.1016/j.clnu.2020.01.004 |
| [22] | Jordan, E.A. and Moore, S.C. (2019) Enteral Nutrition in Critically Ill Adults: Literature Review of Protocols. Nursing in Critical Care, 25, 24-30. https://doi.org/10.1111/nicc.12475 |
| [23] | 孔凡美, 王玉玲. 重症急性胰腺炎早期肠内营养支持研究进展[J]. 中国中西医结合外科杂志, 2018, 24(2): 244-247. |
| [24] | Jin, M., Zhang, H., Lu, B., Li, Y., Wu, D., Qian, J., et al. (2017) The Optimal Timing of Enteral Nutrition and Its Effect on the Prognosis of Acute Pancreatitis: A Propensity Score Matched Cohort Study. Pancreatology, 17, 651-657. https://doi.org/10.1016/j.pan.2017.08.011 |
| [25] | Eckerwall, G.E., Tingstedt, B.B.Å., Bergenzaun, P.E. and Andersson, R.G. (2007) Immediate Oral Feeding in Patients with Mild Acute Pancreatitis Is Safe and May Accelerate Recovery—A Randomized Clinical Study. Clinical Nutrition, 26, 758-763. https://doi.org/10.1016/j.clnu.2007.04.007 |
| [26] | Jabłońska, B. and Mrowiec, S. (2021) Nutritional Support in Patients with Severe Acute Pancreatitis-Current Standards. Nutrients, 13, Article 1498. https://doi.org/10.3390/nu13051498 |
| [27] | Song, J., Zhong, Y., Lu, X., Kang, X., Wang, Y., Guo, W., et al. (2018) Enteral Nutrition Provided within 48 Hours after Admission in Severe Acute Pancreatitis: A Systematic Review and Meta-Analysis. Medicine, 97, e11871. https://doi.org/10.1097/md.0000000000011871 |
| [28] | 曹珂于, 龚姝, 程静霞. 重症急性胰腺炎患者早期肠内营养的最佳证据总结[J]. 华西医学, 2025, 40(4): 561-567. |
| [29] | Al-Omran, M., AlBalawi, Z.H., Tashkandi, M.F. and Al-Ansary, L.A. (2010) Enteral versus Parenteral Nutrition for Acute Pancreatitis. Cochrane Database of Systematic Reviews, No. 1, CD002837. https://doi.org/10.1002/14651858.cd002837.pub2 |
| [30] | Qiu, Z., Cheng, F., Jiang, H., Li, L., Zheng, C., Du, Z., et al. (2020) Efficacy of Microecopharmaceutics Combined with Early Enteral Nutrition Support in the Treatment of Severe Acute Pancreatitis. Journal of the College of Physicians and Surgeons Pakistan, 30, 96-98. https://doi.org/10.29271/jcpsp.2020.01.96 |
| [31] | 中华医学会外科学分会胰腺外科学组. 急性胰腺炎诊治指南(2014版) [J]. 中华消化外科杂志, 2015, 14(1): 1-5. |
| [32] | Jiang, X., et al. (2020) Glutamine Supported Early Enteral Therapy for Severe Acute Pancreatitis: A Systematic Review and Meta-Analysis. Asia Pacific Journal of Clinical Nutrition, 29, 253-261. |
| [33] | 徐静, 刘立鹏, 刘颖, 等. ω-3多不饱和脂肪酸对老年重症急性胰腺炎患者肠黏膜屏障功能的影响[J]. 中国老年学杂志, 2017, 37(9): 2223-2225. |
| [34] | 朱晓丽, 刘宇, 张翼, 等. 谷氨酰胺强化肠内营养对重症急性胰腺炎大鼠Treg/Th17平衡的影响及机制[J]. 中国免疫学杂志, 2023, 35(1): 59-64. |
| [35] | 王立婷, 乔娜, 常树玲, 等. 联合谷氨酰胺的强化肠内营养对重症急性胰腺炎患者疗效的荟萃分析[J]. 外科研究与新技术(中英文), 2025, 14(1): 23-30. |
| [36] | Arutla, M., Raghunath, M., Deepika, G., Jakkampudi, A., Murthy, H.V.V., Rao, G.V., et al. (2019) Efficacy of Enteral Glutamine Supplementation in Patients with Severe and Predicted Severe Acute Pancreatitis—A Randomized Controlled Trial. Indian Journal of Gastroenterology, 38, 338-347. https://doi.org/10.1007/s12664-019-00962-7 |
| [37] | Wark, G., Samocha-Bonet, D., Ghaly, S. and Danta, M. (2020) The Role of Diet in the Pathogenesis and Management of Inflammatory Bowel Disease: A Review. Nutrients, 13, Article 135. https://doi.org/10.3390/nu13010135 |
| [38] | Schröder, O., Hoepffner, N. and Stein, J. (2004) Enteral Nutrition by Endoscopic Means; I. Techniques, Indications, Types of Enteral Feed. Zeitschrift für Gastroenterologie, 42, 1385-1392. https://doi.org/10.1055/s-2004-813806 |
| [39] | 姜涵, 陈旭. 谷氨酰胺联合早期肠内营养治疗重症急性胰腺炎的效果及对营养指标和炎性因子的影响[J]. 临床合理用药, 2025, 18(6): 97-99. |
| [40] | Ito, M.K. (2015) Long-Chain ω-3 Fatty Acids, Fibrates and Niacin as Therapeutic Options in the Treatment of Hypertriglyceridemia: A Review of the Literature. Atherosclerosis, 242, 647-656. https://doi.org/10.1016/j.atherosclerosis.2015.06.012 |
| [41] | Pan, L., Li, J., Shamoon, M., Bhatia, M. and Sun, J. (2017) Recent Advances on Nutrition in Treatment of Acute Pancreatitis. Frontiers in Immunology, 8, Article 762. https://doi.org/10.3389/fimmu.2017.00762 |
