重症急性胰腺炎的营养支持疗法

Nutritional support therapy in severe acute pancreatitis

营养支持疗法在重症急性胰腺炎（SAP）的治疗中有着举足轻重的作用。SAP患者入院后如5~7 d不能经口进食应开始营养支持治疗,肠内营养（EN）较肠外营养（PN）能减少并发症及病死率,EN优于PN,在入院48 h内开展EN对SAP的转归有积极的作用。鼻空肠（nasojejunal,NJ）营养途径仍是EN的主要方式,新近研究表明,SAP患者使用鼻胃管营养途径（NG）亦是可行的,但尚有争议。半要素或要素型EN营养制剂的使用经验和临床研究还不充分,推荐应用谷氨酰胺。促动力药、免疫增强型EN营养制剂及益生菌不作为常规推荐。

Nutrition in severe acute pancreatitis is a critical aspect in the management of this condition. Nutritional support therapy is indicated if patients cannot consume normal food after 5 - 7 days or when it becomes evidence that the patient will not be able to tolerate oral intake for a prolonged period of time （7 days or more）. EN is preferred over PN,because it re- duces complications and mortality in AP. PN only be used in patients unable to tolerate EN. It is likely that EN has a benefi- cial influence on the disease course and should be initiated as early as possible （ with 48 hours of admission）. It can be stat- ed that nasogastrict tube feeding in SAP is possible. The clinical evidence for the use of just （semi） elemental formulas is weak. Glutamine is recommended. Supplementation of enteral formulas with and prebiotics and the use of immune enhancing formulas cannot routinely be recommended.