高脂血症性急性胰腺炎的营养支持策略

Strategies of nutritional support for patients with hyperlipidemic acute pancreatitis

目的探讨高脂血症性急性胰腺炎（HLAP）的营养支持策略。方法回顾性分析1998年1月至2009年12月在北京协和医院国际医疗部就诊的6例HLAP患者9次急性胰腺炎发作的临床资料。结果经禁食、尽早开始营养支持和降脂治疗后，所有患者的病情均好转。3例重症HLAP患者留置空肠营养管，管饲低脂肠内营养和降脂；3例轻症患者低脂饮食和口服降脂药。所有患者的血三酰甘油水平均明显下降，由（25．30±20．48）mmol／L降至（5．41±4．55）mmoL／L，随诊3—24个月无复发。结论HLAP患者宜根据病情个体化选择营养途径，合理搭配肠内营养制剂和降脂药物。重症HLAP宜早期留置空肠营养管，以保证肠内营养和降脂药物的使用，保护肠黏膜屏障，减少血糖波动。

Objective To summarize the strategies of nutritional support for patients with hyperlipidemic acute pancreatitis （HLAP）. Methods The clinical data of six HLAP patients who were treated in our department from January 1998 to December 2009 were retrospectively reviewed. Results The disease conditions of all patients were improved after fasting and early nutritional support and lipid-lowering treatment. Three cases with severe HLAP received enteral nutrition via a nasojejunal tube. Another three patients with milder HLAP obtained low-fat diet and orally administered lipid-lowering drugs. The plasma triglyceride levels decreased from （25.30±20. 48 ） mmol/L to （5.41±4.55） mmol/L. No relapse was noted during follow-up （range： 3-24 months）. Conclusions The ap- proaches of nutritional support for HLAP patients should be customized based on the specific disease conditions, and the enteral nutrition and lipid-lowering drugs should be reasonably and carefully designed and applied. For severe HLAP, nasojejunal tube should be maintained in the early stage to ensure the apphcation of enteral nutrition and lipid-lowering drugs, protect the integrity of gut mucosal barrier, and decrease the fluctuation of blood glucose.