无脂肠内营养治疗重症急性胰腺炎乳糜腹水的疗效分析

The effect of fat-free enteral nutrition for chylous ascites secondary to SAP

目的：观察无脂肠内营养（EN）在治疗重症急性胰腺炎（SAP）乳糜腹水的效果。方法：回顾分析5例SAP并发乳糜腹水病人的治疗。5例病人在罹患SAP后,腹部CT提示腹腔积液,予B超引导下穿刺或手术引流,引流液为乳白色,乳糜试验阳性,诊断为乳糜腹水。5例病人均首先给予无脂EN,成分为水解蛋白质粉5.2~7.8 g/（kg.d）能量[104.6~146.4 kJ（25~35 kcal）/（kg.d）]。监测腹水引流量及其三酰甘油浓度和乳糜试验的变化。结果：5例病人应用无脂EN治疗后,短时间内腹水乳糜试验即转为阴性,三酰甘油浓度显著下降,引流量逐渐减少,4例病人治愈,但1例于1个月后又出现乳糜腹水,再次给予无脂EN治疗11 d,无效,于第12天开始给予全肠外营养（TPN）联合生长抑素治疗,15 d后腹水消失;另1例病人经无脂EN治疗27 d后腹水未消退,遂改用TPN联合生长抑素治疗12 d后治愈。结论：无脂EN是治疗SAP并发乳糜腹水的一种有效方法。

Objective： To observe the effect of fat-free enteral nutrition for chylous ascites secondary to SAP.Methods： From October 2008 to March 2009,five patients with chylous ascite secondary to SAP had been enrolled in this retrospective study.They were diagnosed as ascites secondary to SAP,and were drainaged by abdominal operation or with the guidance of B ultrolsound or CT.Chylous ascites were diagnosed by the ＂milky＂ appearance and the positive chyle test.The nutritional support with fat-free formula which supplied hydrolyzed protein powder composition for 5.2~7.8 g/（kg·d） [104.6～146.4 kJ（25~35 kcal）/（kg·d）] were given to all patients.The volume,the TG concentration and the chyle test of ascites were monitored.Results： With the supporting of fat-free EN,the chyle test of ascites appeared negative soon,and the TG and the drainage volume of ascites decreased significantly.One month later,chylous ascites reoccurred in one patient and then fat-free EN were given for 11 days.In order to shorten the course of treatment,on the 12th day TPN with somatostatin was used,and ascites disappeared 15 days later.The one who didn＇t recover with 27day＇s fat-free EN supporting was treated with TPN and somatostatin,was recovered on the 12th day.Conclusion： Fat-free EN is an effective method for curing chylous ascites secondary to SAP.