204例重症急性胰腺炎的个体化阶段性肠内营养回顾分析

Retrospective analysis of individualized and staged enteral nutrition in treatment of 204 cases of severe acute pancreatitis

目的探讨个体化阶段性肠内营养在重症急性胰腺炎中的使用及作用。方法对福建医科大学附属协和医院普外科2000年1月至2008年3月204例采用个体化阶段性肠内营养支持治疗的SAP病例资料进行归纳分析，了解个体化及阶段性肠内营养在SAP治疗中的重要意义。结果住院期间经过个体化阶段性肠内营养，SAP病人肝功、血脂恢复正常，胰性脑病消失，恢复正常饮食，拔除营养管痊愈出院。有伴发假性囊肿的病人根据实时监测结果调整肠内营养，使其达到对囊肿的最小影响后带管出院，门诊随访。经过治疗囊肿自行吸收者49例，延期经过3个月行内引流术者32例。病人施行肠内营养时间为20～95d。结论SAP病人经过急性期的处理后进行肠内营养是安全而且是必需的，但需注意因人而异的“个体化”及循序渐进的“阶段性”，让肠内营养在SAP的治疗中发挥更重要的作用。

Objective To investigate the role of individualized and staged enteral nutrition in the treatment of severe acute panereatitis（SAP）. Methods The clinical data of 204 cases of SAP treated with individualized stage enteral nutrition in our hospital from January 2000 to March 2008 were retrospectively analyzed. Results The liver function and serum lipid and diet returned to the normal level after the treatment. Pancreatic encephalopathy disappeared. The patients recovered and were discharged from the hospital with the extraction of feeding tube. Enteral nutrition was adjusted based on the monitoring results in the hospitalization period that brought less effect to the pseudocyst of pancreas, and then discharged from the hospital with the feeding tube. The pseudocyst in 49 cases disappeared spontaneously and it was cured with internal drainage for 3 months in other 32. The time of enteral nutrition was 20-95 d. Conclusion Enteral nutrition is safe and necessary after the acute stage of SAP. To ensure the enteral nutrition to play a more important role in the treatment of SAP, we must pay more attention on the individualization and stage of enteral nutrition.