重症急性胰腺炎患者的代谢特点与营养支持

Metabolic Features of Severe Acute Pancreatitis and Its Nutrition Support

重症急性胰腺炎(SAP)是十分危险的急性全身消耗性疾病,死亡率高。机体处于高分解代谢和低合成代谢状态,蛋白质、糖与脂肪代谢呈持续紊乱性消耗,其中蛋白质消耗是静息状态消耗的1.5倍。在营养支持过程中,葡萄糖应不超过4mg/(kg·min),同时合理应用脂肪乳,避免出现脂肪超载综合征;蛋白质输入量应维持在1.2～1.5g/(kg·d),应用谷氨酰胺防止发生肠黏膜萎缩。在胃肠功能逐渐恢复后可通过鼻肠管进行肠内营养,使营养支持从肠外营养与肠内营养相结合的模式,逐渐过渡为肠内营养。

Severe acute pancreatitis （SAP） is a serious condition with high mortality rate. It is associated with organ failure and local complication such as necrosis, abscess, and pseudocyst formation. The body is under a high catabolism and low anabolism condition. The expenditures of nitrogen, carbohydrate, and lipids are under a disorderly condition, among which the expenditure of nitrogen is 1.5 times of that of the rest status. During nutrition support, glucose should be infused at a rate of no more than 4 mg/（ kg · min） ; lipid emulsion should be appropriately appied to avoid lipid excess syndrome. Protein infusion should be maintained at 1.2-1.5 g/（ kg · d）, and glutamine can be used to prevent gut mucosal atrophy. After the guts function returns, the nutrition support may gradually change from parenteral nutrition plus enteral nutrition to and enteral nutrition only.