急性胰腺炎的肠内营养支持治疗进展

Progress on enteral nutrition therapy for acute pancreatitis

急性胰腺炎(acute pancreatitis,AP)是一种以上腹痛、胰酶升高和胰腺影像学改变为特征的严重程度不同的急性炎症疾病。根据胰腺损伤的程度和全身性器官衰竭的存在与否和持续时间的长短,急性胰腺炎可分为轻度、中度和重度。多数患者表现为轻度AP并迅速康复,但高达20%的患者会进展为中度或重度AP,死亡风险可高达30%。重症急性胰腺炎是一种临床急症,病情危重、预后较差,尤以是伴有胰腺和/或胰周组织感染坏死为甚。AP本质上是一种炎症过程,可导致蛋白质分解代谢和代谢率增加,可导致负氮平衡。急性胰腺炎营养支持治疗的目标是通过维持肠道内环境和肠屏障功能,纠正负氮平衡,减轻炎症反应以改善预后。肠内营养治疗是目前临床治疗重症急性胰腺炎的重要组成部分。文章根据现有的临床研究结果及AP的肠内营养治疗进行综述。

Acute pancreatitis(AP)is an acute inflammatory disease of various severity,characterized by upper abdominal pain,elevated pancreatic enzymes,and changes in imaging features of the pancreas.According to the degree of pancreatic injury and the presence and duration of systemic organ failure,AP is classified into mild,moderate,or severe disease.Most AP patients experience mild disease and recover quickly,while up to 20%progress to moderate or severe disease,with an estimated risk of death as high as 30%.Severe acute pancreatitis(SAP)is a clinical emergency with a critical condition and poor prognosis,especially in patients with pancreatic and/or peripancreatic tissue infection and necrosis.AP is essentially an inflammatory process that can lead to protein catabolism and increased metabolic rates,further resulting in negative nitrogen balance.The goal of nutritional support therapy for AP is to correct negative nitrogen balance,reduce inflammation,and improve prognosis.Enteral nutrition therapy is an important component of clinical treatment of SAP.This review aims to summarize the nutritional support treatment in AP based on the existing clinical data and experience.