CAJ | 학술논문

目的了解营养支持和生长抑素对重症胰腺炎的治疗作用.方法近2年来对10例重症胰腺炎给予营养支持和生长激素治疗(治疗组),并与早期仅用TPN支持的10例重症胰腺炎(对照组)进行比较.所有病人均经淀粉酶、B超、CT及腹腔穿刺液确诊,根据APACHEⅡ评分,>9分为重症胰腺炎.结果两组病人各有1例死亡,差异无显著性,但治疗组并发症较少,住院时间缩短,与对照组比较差异有显著性P<0.05.结论1.重症胰腺炎是肠外营养支持的适应证,而轻型胰腺炎可不必给予肠外营养支持,因此急性胰腺炎的临床分级是十分重要的,APACHⅡ评分能较全面地对此作出评价.2.PN能改善重症胰腺炎病人的营养状态,减少胰腺和消化液的分泌,但并不能达到理想的效果.3.生长抑素能明显抑制胰腺及消化道分泌,与PN合用能减少病人并发症发生率,缩短住院时间.4.应注意保护重症胰腺炎的胃肠道粘膜屏障功能,这对阻断或减轻全身炎性反应综合症有重要意义,早期少量口服谷氨酰胺是可取的,且未见增加胰腺负担,有条件者静脉给予足量谷氨酰双肽更好.5.急性胰腺炎病重期给予静脉输注血浆白蛋白十分重要,它能强化PN治疗,及时提高血浆胶体渗透压,发挥白蛋白运输和抗氧化等生理作用.6.手术病人应置空肠造瘘,以便能早期开始肠内营养,要素饮食经空肠给予无明显胰腺刺激作用.合理的营养支持加生长抑素对重症胰腺炎能改善机体营养状态,进一步减少胰腺分泌,降低重症胰腺炎的并发症,缩短住院时间.
목적료해영양지지화생장억소대중증이선염적치료작용.방법근2년래대10례중증이선염급여영양지지화생장격소치료(치료조),병여조기부용TPN지지적10례중증이선염(대조조)진행비교.소유병인균경정분매、B초、CT급복강천자액학진,근거APACHEⅡ평분,>9분위중증이선염.결과량조병인각유1례사망,차이무현저성,단치료조병발증교소,주원시간축단,여대조조비교차이유현저성P<0.05.결론1.중증이선염시장외영양지지적괄응증,이경형이선염가불필급여장외영양지지,인차급성이선염적림상분급시십분중요적,APACHⅡ평분능교전면지대차작출평개.2.PN능개선중증이선염병인적영양상태,감소이선화소화액적분비,단병불능체도이상적효과.3.생장억소능명현억제이선급소화도분비,여PN합용능감소병인병발증발생솔,축단주원시간.4.응주의보호중증이선염적위장도점막병장공능,저대조단혹감경전신염성반응종합증유중요의의,조기소량구복곡안선알시가취적,차미견증가이선부담,유조건자정맥급여족량곡안선쌍태경호.5.급성이선염병중기급여정맥수주혈장백단백십분중요,타능강화PN치료,급시제고혈장효체삼투압,발휘백단백운수화항양화등생리작용.6.수술병인응치공장조루,이편능조기개시장내영양,요소음식경공장급여무명현이선자격작용.합리적영양지지가생장억소대중증이선염능개선궤체영양상태,진일보감소이선분비,강저중증이선염적병발증,축단주원시간.
Objective To evaluate the effect of Nutrtion Support with Somatostatin for patients with severe pancreantitis (Acute Hemorrhagic pancreantitis). Methods In a two years period, we selected 20 patients with severe pancreantitis, and divided them into two groups randomly. In group A (the treating group), we used TPN Plus Somatostatin, In group B (the control group) ,we just used the traditionalTPN support. All the patients in the study were diagnosed by serum amylase, ultrasound detection, CT and peritoneocentesis. Their APACH Ⅱ score were all above 9 and confirm to be severe pancreantitis. Results There was one patient died in each group, the mortality was no significant. But the occurrence of complications of group A Was decreased, and the length of in hospital was stay shortened (P<0.05). Conclusions 1. TPN could meet the hypermetabolic need of the patients with severe pancreantitis, but it was not necessary for those who just had moderate acute pancreantitis. So the APACH Ⅱ Grade was very important to condition assessment and the selection of candidates for TPN. 2. PN could improve the nutrition state of the patients with severe pancreantitis, reduce the excretion of pancreas and other digestive glands, but it could not achieve the best results for signle using. 3. Somatostatin could obviously compress the excretion of pancreas and digestive tracts, the administration of it plus PN can cut down the occurrence of complication and shorten the treating days. 4. To protect the gastric and intestind mucous barrier is crucial, it would be helpful in obstructing and alleviate the Systemic Inflammatory Response Syndrome (SIRS). We have observed that taking low-dose glutamine in early stage of severe pancreantitis didn't aggravate the burden of pancreas, and the intravenous injection of dipeptid glutamine had much better results. 5. It was also important for severe patients to be given plasma albumin by intravenous drops. It could strengthen the effect of PN, heighten the Plasmatic Colloid Osmotic Pressure, and had the effect of transportation and anti-oxidation. 6. The patients scheduled for operations had better to have jejunostomy so as to use enteral nutrtition earlier, and the elemental nutrition given through the jejunum had little stimulation to pancreas. Rational administration of TPN with somatostatin can improve the nutritional status of the patients with severe pancreantitis, decrease the excretion of pancreas and shorten the treating days.