切换至 "中华医学电子期刊资源库"

中华普通外科学文献(电子版) ›› 2023, Vol. 17 ›› Issue (05) : 385 -390. doi: 10.3877/cma.j.issn.1674-0793.2023.05.014

综述

重症急性胰腺炎营养支持治疗研究进展
黄翠君, 张喜玲, 刘思嘉, 刘云建()   
  1. 332005 九江市第一人民医院体检中心
    274000 菏泽市立医院输液中心
    332001 九江学院附属医院麻醉科
    332001 九江学院附属医院肝胆外科
  • 收稿日期:2023-06-16 出版日期:2023-10-01
  • 通信作者: 刘云建
  • 基金资助:
    江西省自然科学基金面上项目(20202BABL206092); 江西省教育厅科学技术研究项目(GJJ161064)

Research progress in nutritional support therapy for severe acute pancreatitis

Cuijun Huang, Xiling Zhang, Sijia Liu, Yunjian Liu()   

  1. Medical Examination Center, Jiujiang No.1 People’s Hospital, Jiujiang 332005, China
    Infusion Center, Heze Municipal Hospital, Heze 274000, China
    Department of Anesthesiology, Jiujiang University Affiliated Hospital, Jiujiang 332001, China
    Department of Hepatobiliary Surgery, Jiujiang University Affiliated Hospital, Jiujiang 332001, China
  • Received:2023-06-16 Published:2023-10-01
  • Corresponding author: Yunjian Liu
引用本文:

黄翠君, 张喜玲, 刘思嘉, 刘云建. 重症急性胰腺炎营养支持治疗研究进展[J]. 中华普通外科学文献(电子版), 2023, 17(05): 385-390.

Cuijun Huang, Xiling Zhang, Sijia Liu, Yunjian Liu. Research progress in nutritional support therapy for severe acute pancreatitis[J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(05): 385-390.

重症急性胰腺炎(SAP)导致许多炎症和营养障碍,SAP患者营养风险都很高。适当的营养治疗可以显著降低SAP患者的感染并发症发生率和死亡率。早期(24~48 h内开始)肠内营养(EN)是大多数患者的最佳选择,可减轻继发于胰腺炎症的胃肠运动障碍,从而保护肠道屏障功能。目前,肠外营养(PN)在SAP患者中的应用仅限于EN不可能或禁忌的情况。本文综述了SAP患者早期与延迟EN、鼻胃管与鼻空肠管EN、EN与PN以及免疫营养在SAP患者中的作用进展。

Severe acute pancreatitis (SAP) leads to numerous inflammatory and nutritional disturbances. All SAP patients are at a high nutritional risk. It has been proved that proper nutrition significantly reduces mortality rate and the incidence of infectious complications in SAP patients. Early (started within 24-48 h) enteral nutrition (EN) is optimal in most patients. EN protects gut barrier function because it decreases gastrointestinal dysmotility secondary to pancreatic inflammation. Currently, the application of parenteral nutrition (PN) in SAP is limited to those patients in whom EN is not possible or contraindicated. Early versus delayed EN, EN versus PN and the role of immunonutrition in SAP patients are discussed in this review.

[1]
Rijkers AP, van Eijck CH. Acute pancreatitis[J]. N Engl J Med, 2017, 376(6): 596-597.
[2]
Gomes CA, Di Saverio S, Sartelli M, et al. Severe acute pancreatitis: eight fundamental steps revised according to the 'PANCREAS’ acronym[J]. Ann R Coll Surg Engl, 2020, 102(8): 555-559.
[3]
Murphy AE, Codner PA. Acute pancreatitis: exploring nutrition implications[J]. Nutr Clin Pract, 2020, 35(5): 807-817.
[4]
Khaliq A, Dutta U, Kochhar R, et al. Management of acute pancreatitis: "PANCREAS" contains eight easy steps to remember the treatment[J]. JOP, 2010, 11(5): 492-493.
[5]
Kanthasamy KA, Akshintala Vs, Singh VK. Nutritional management of acute pancreatitis[J]. Gastroenterol Clin North Am, 2021, 50(1): 141-150.
[6]
Yi F, Ge L, Zhao J, et al. Meta-analysis: total parenteral nutrition versus total enteral nutrition in predicted severe acute pancreatitis[J]. Intern Med, 2012, 51(6): 523-530.
[7]
Cao YXu YLu T,et al. Meta-analysis of enteral nutrition versus total parenteral nutrition in patients with severe acute pancreatitis[J]. Ann Nutr Metab, 2008, 53(3-4): 268-275.
[8]
Weimann A, Felbinger TW. Gastrointestinal dysmotility in the critically ill: A role for nutrition[J]. Curr Opin Clin Nutr Metab Care, 2016, 19(5): 353-359.
[9]
Hongyin L, Zhu H, Tao W, et al. Abdominal paracentesis drainage improves tolerance of enteral nutrition in acute pancreatitis: A randomized controlled trial[J]. Scand J Gastroenterol, 2017, 52(4): 389-395.
[10]
Sun JK, Mu XW, Li WQ, et al. Effects of early enteral nutrition on immune function of severe acute pancreatitis patients[J]. World J Gastroenterol, 2013, 19(6): 917-922.
[11]
Song J, Zhong Y, Lu X, et al. Enteral nutrition provided within 48 h after admission in severe acute pancreatitis: A systematic review and meta-analysis[J]. Medicine(Baltimore), 2018, 97: e11871.
[12]
Li JY, Yu T, Chen GC, et al. Enteral nutrition within 48 h of admission improves clinical outcomes of acute pancreatitis by reducing complications: A meta-analysis[J]. PLoS One, 2013, 8: e64926.
[13]
McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)[J]. JPEN J Parenter Enteral Nutr, 2016, 40(2): 159-211.
[14]
Singh N, Sharma B, Sharma M, et al. Evaluation of early enteral feeding through nasogastric and nasojejunal tube in severe acute pancreatitis: A noninferiority randomized controlled trial[J]. Pancreas, 2012, 41(1): 153-159.
[15]
Nally DM, Kelly EG, Clarke M, et al. Nasogastric nutrition is efficacious in severe acute pancreatitis: A systematic review and meta-analysis[J]. Br J Nutr, 2014, 112(11): 1769-1778.
[16]
Petrov MS, Loveday BP, Pylypchuk RD, et al. Systematic review and meta-analysis of enteral nutrition formulations in acute pancreatitis[J]. Br J Surg, 2009, 96(11): 1243-1252.
[17]
Endo A, Shiraishi A, Fushimi K, et al. Comparative effectiveness of elemental formula in the early enteral nutrition management of acute pancreatitis: A retrospective cohort study[J]. Ann Intensive Care, 2018, 8(1): 69.
[18]
Zhang SY, Liang ZY, Yu WQ, et al. Early enteral nutrition with polymeric feeds was associated with chylous ascites in patients with severe acute pancreatitis[J]. Pancreas, 2014, 43(4): 553-558.
[19]
Liang XY, Wu XA, Tian Y, et al. Effects of early versus delayed feeding in patients with acute pancreatitis: A systematic review and meta-analysis[J]. J Clin Gastroenterol, 2023, doi: 10.1097/MCG.0000000000001886.
[20]
Jablońska B, Mrowiec S. The role of immunonutrition in patients undergoing pancreaticoduodenectomy[J]. Nutrients, 2020, 12(9): 2547.
[21]
Poropat G, Giljaca V, Hauser G, et al. Enteral nutrition formulations for acute pancreatitis[J]. Cochrane Database Syst Rev, 2015, (3): CD010605.
[22]
Jafari T, Feizi A, Askari G, et al. Parenteral immunonutrition in patients with acute pancreatitis: A systematic review and meta-analysis[J]. Clin Nutr, 2015, 34(1): 35-43.
[23]
Zhou J, Xue Y, Liu Y, et al. The effect of immunonutrition in patients with acute pancreatitis: A systematic review and meta-analysis[J]. J Hum Nutr Diet, 2021, 34(2): 429-439.
[24]
王迎芝, 张先进, 杨士彦. 益生菌结合早期肠内营养对重症急性胰腺炎患者营养状况、肠黏膜屏障功能及肠内营养耐受性的影响[J/CD]. 中华消化病与影像杂志(电子版), 2023, 13(1): 55-58.
[25]
Gou S, Yang Z, Liu T, et al. Use of probiotics in the treatment of severe acute pancreatitis: A systematic review and meta-analysis of randomized controlled trials[J]. Crit Care, 2014, 18(2): R57.
[26]
Besselink MG, van Santvoort HC, Buskens E, et al. Probiotic prophylaxis in predicted severe acute pancreatitis: A randomised, double-blind, placebo-controlled trial[J]. Lancet, 2008, 371(9613): 651-659.
[27]
Wang G, Wen J, Xu L, et al. Effect of enteral nutrition and ecoimmunonutrition on bacterial translocation and cytokine production in patients with severe acute pancreatitis[J]. J Surg Res, 2013, 183(2): 592-597.
[28]
Arvanitakis M, Ockenga J, Bezmarevic M, et al. ESPEN guideline on clinical nutrition in acute and chronic pancreatitis[J]. Clin Nutr, 2020, 9(3): 612-631.
[29]
Crockett SD, Wani S, Gardner TB, et al. American Gastroenterological Association Institute Guideline on initial management of acute pancreatitis[J]. Gastroenterology, 2018, 154(4): 1096-1101.
[30]
Wu LM, Sankaran SJ, Plank LD, et al. Meta-analysis of gut barrier dysfunction in patients with acute pancreatitis[J]. Br J Surg, 2014, 101(13): 1644-1656.
[31]
刘世洲, 姚佳柔, 莫绍剑, 等. 重症急性胰腺炎营养支持研究进展[J/CD]. 中华肝脏外科手术学电子杂志, 2021, 10(5): 533-535.
[1] 尹朱丹, 王昱, 镇坷, 许彬, 田雅丽, 童孜蓉. 早期低热量肠内营养对危重症患者预后影响的Meta分析[J]. 中华危重症医学杂志(电子版), 2023, 16(03): 215-222.
[2] 杨晶, 高青. 重症急性胰腺炎继发脓毒症的危险因素分析[J]. 中华危重症医学杂志(电子版), 2023, 16(02): 105-110.
[3] 杨萍, 许世敏, 李亮亮, 尹向云, 锡洪敏, 马丽丽, 李向红. 早产儿支气管肺发育不良合并代谢性骨病的影响因素[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(02): 202-211.
[4] 李佳丽, 吴杨, 张莉, 夏斌, 何洋, 陈忠, 唐军, 母得志. 新生儿消化道穿孔患儿的临床特点及治疗结局[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(06): 703-711.
[5] 周铖, 袁野, 张鹏, 蔡明, 陈俊华, 尹玉平, 李伟, 向帆, 李钢, 陶凯雄, 王征, 王国斌. 小肠移植新时期:成就与挑战并存[J]. 中华普外科手术学杂志(电子版), 2022, 16(06): 703-706.
[6] 罗东明, 钟倩, 陈德伦, 诸葛冬桂, 邹世镇, 汪志华. 早期肠内营养支持对胃癌术后患者肠黏膜屏障功能保护的研究进展[J]. 中华普外科手术学杂志(电子版), 2022, 16(06): 700-702.
[7] 袁玉霞, 何永琴, 张雅妮, 匡芸芸, 张月, 张玉梅. 老年COPD髋部骨折患者围术期肠内营养治疗效果分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(01): 83-85.
[8] 高军龙, 张昕, 周倩倩, 袁媛. 重症急性胰腺炎早期免疫抑制的研究进展[J]. 中华重症医学电子杂志, 2023, 09(03): 286-291.
[9] 顾国英, 黄迎春, 刘佳, 居建明, 于国锋, 蒋荣. 个体化肠外营养在肠切除伴肠功能障碍患者中的应用研究[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 489-493.
[10] 张雯, 宋牡丹, 邓雪婷, 张云. 强化营养支持辅助奥曲肽治疗肝硬化合并食管胃底静脉曲张破裂出血的疗效及再出血危险因素[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 456-460.
[11] 王小红, 钱晶, 翁文俊, 周国雄, 朱顺星, 祁小鸣, 刘春, 王萍, 沈伟, 程睿智, 秦璟灏. 巯基丙酮酸硫基转移酶调控核因子κB信号介导自噬对重症急性胰腺炎大鼠的影响及机制[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 422-426.
[12] 马强, 李军, 苟丽娟. 重症急性胰腺炎miR-21-3p、RUNX3表达水平及对病情发展程度的预测[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 337-341.
[13] 屠松霞, 郑红艳, 朱姝, 徐夏君. 食管癌术后患者肠内营养耐受不良的影响因素及列线图风险模型[J]. 中华消化病与影像杂志(电子版), 2023, 13(02): 73-77.
[14] 王迎芝, 张先进, 杨士彦. 益生菌结合早期肠内营养对重症急性胰腺炎患者营养状况、肠黏膜屏障功能及肠内营养耐受性的影响[J]. 中华消化病与影像杂志(电子版), 2023, 13(01): 55-58.
[15] 李平, 梁伟芬, 张艺军, 肖桂珍, 郑林鑫, 李好华. 营养支持在老年晚期肺癌患者呼吸康复治疗中的作用[J]. 中华老年病研究电子杂志, 2023, 10(01): 20-25.
阅读次数
全文


摘要