重症急性胰腺炎空肠营养支持治疗中肠道不耐受的防治

Enteral feeding intolerance in patients with severe acute pancreatitis:causes and management

目的:探讨重症急性胰腺炎(SAP)病人肠内营养(EN)支持治疗中肠道不耐受的原因和防治方法。方法:回顾研究128例SAP病人行EN支持治疗出现的肠道不耐受现象。结果:使用肠内输液泵、一次性EN输注器和加热器的病人78例,5例出现肠道不耐受;未使用输注系统50例,10例出现肠道不耐受。后者肠道不耐受发生率显著高于前者。15例肠道不耐受病人中,4例改用空肠输注系统后,肠道不耐受症状消失。2例降低滴注营养液浓度后,肠道不耐受症状消失。9例病人转为手术治疗,术中发现8例伴小肠充血水肿,1例小肠部分缺血坏死。8例病人出现胰周感染,术后8例可耐受EN支持治疗。结论:在使用EN支持治疗时,常规使用空肠滴注泵、一次性EN输注器和加热器,可防治SAP病人营养支持治疗中出现的肠道不耐受症状。

Objective：To investigate the causes and management of enteral feeding intolerance in patients with severe acute pancreatitis （SAP）. Methods： The clinical data were retrospectively analyzed of 128 SAP patients who underwent enteral feeding treatment during the period from January 2006 to January 2008. Results： The rate of enteral feeding intolerance was significantly higher in the group of patients who didn＇ t use Flocare 800 pump, single-use enteral feeding tube and heater （10/50 or 20.0%） than that in the group of patients who used Flocare 800 pump, single-use enteral feeding tube and heater （5/78 or 6.4%）. Conclusion：The possible risk factors of enteral feeding intolerance may be transfusional speed, temperature and concentration of nutritional fluid. Severity of acute pancreatitis is another important factor. Intestinal dysfunction should be noticed during the enteral nutritional support.