重症急性胰腺炎早期肠内营养支持治疗

Early enteral nutrition for severe acute pancreatitis

近年来重症急性胰腺炎(severe acute pancreatitis,SAP)的营养模式发生了显著的变化,大致分为3个阶段:全胃肠外营养模式、阶段性营养支持模式和早期肠内营养模式。21世纪初期开始的早期肠内营养,即在SAP的急性期内,血流动力学和内稳态稳定后,立即建立空肠营养通道,开始肠内营养,只有当肠内营养不能实施时,才考虑用肠外营养。早期肠内营养不仅仅单纯作为"营养",而是同时作为调节过度炎性反应和预防肠源性感染的手段。越来越多的证据表明,早期肠内营养能够明显改善SAP预后,降低胰腺坏死组织感染发生率。

In recent years, the nutrition pattern for severe acute pancreatitis （SAP） is changing dramatically, which can be divided into three stages： total parenteral nutrition, stage nutrition support and early enteral nutrition. Early enteral nutrition （EEN） has been developed since early 21st century. In acute phase of SAP, once haemodynamics and homeostasis are stable, jejunal tube should be placed and enteral feeding should be started. Supplemental parenteral nutrition should be used only in patients who cannot be fed sufficiently via the enteral route. Early enteral nutrition is not only ＂feeding＂, EEN can decrease excessive inflammtion response and prevent enterogenic infection. There is growing evidence that EEN can improve prognosis and reduce pancreatic necrotic infection in SAP patients.