急性胰腺炎的肠内营养:从“胰腺休息”到“肠道唤醒”

The transformation of enteral nutrition therapy in acute pancreatitis

急性胰腺炎(AP)在全球是一种常见病、多发病。其病理生理过程复杂,有着较高的并发症发生率及死亡率。目前对于AP的治疗主要集中在营养治疗上,尤其是肠内营养。早期AP因受到"胰腺休息"理论的影响,故在其进食或肠内营养治疗上很保守。往往需要等到患者血淀粉酶正常,腹痛消失后。到20世纪末,随着临床营养学的发展,临床医生发现禁食带来的危害远超出人们的想象。例如:肠粘膜萎缩、肠道免疫功能障碍、肠源性感染、急性炎症反应综合症、器官功能衰竭等。往往会造成重症急性胰腺炎(SAP)患者死亡,而后开始重视肠道粘膜屏障的保护。此时许多动物及人体实验发现,早期进食并不会引起胰酶的大量分泌,反而会维持肠粘膜细胞的正常生理代谢,保护了肠道粘膜屏障,减少了并发症和死亡率。此时"胰腺休息"理论已经逐渐退出历史舞台,"肠道唤醒"的理论已兴起。

Acute pancreatitis(AP)is a common disease in the world.Its pathophysiological process is complex,with a high incidence of complications and mortality.At present,the AP treatment is focused on nutrition therapy,especially enteral nutrition.Because of the“pancreas rest”theory,so it is very conservative the therapeutic feeding or enteral nutrition.Patients usually have to wait until the serum amylase is normal and abdominal pain disappears.By the end of twentieth century,with the development of clinical nutriology,clinicians began to find that the harm caused by abrosia was far beyond people s imagination.For example,intestinal mucosal atrophy,intestinal immune dysfunction,intestinal infection,acute inflammatory response syndrome,organ failure,and so on.It often causes death in patients with severe acute pancreatitis.Clinicians then began to attach importance to the protection of the intestinal mucosal barrier.Many animal and human experiments have found that early feeding does not cause secretion of pancreatin,but will maintain normal metabolism of intestinal mucosa,protect the intestinal mucosal barrier,and reduce complications and mortality.At present,“pancreas rest”theory has gradually dropped out of the stage of history,and“gut rousing”theory is on the rise.