营养支持加生长抑素对重症胰腺炎的治疗作用
作者：徐鹏远 陈加勇 许世才 谭晶 王兴贤
单位：昆明医学院附属二院普外科 650101
关键词：
中国临床营养杂志000150摘 要：目的了解营养支持和生长抑素对重症胰腺炎的治疗作用。 方法近2年来对10例重症胰腺炎给予营养支持和生长激素治疗(治疗组)，并与早期仅用TPN支持的10例重症胰腺炎(对照组)进行比较。所有病人均经淀粉酶、B超、CT及腹腔穿刺液确诊，根据APACHEⅡ评分，>9分为重症胰腺炎。 结果两组病人各有1例死亡，差异无显著性，但治疗组并发症较少，住院时间缩短，与对照组比较差异有显著性P<0.05。 结论1.重症胰腺炎是肠外营养支持的适应证，而轻型胰腺炎可不必给予肠外营养支持，因此急性胰腺炎的临床分级是十分重要的，APACHⅡ评分能较全面地对此作出评价。2.PN能改善重症胰腺炎病人的营养状态，减少胰腺和消化液的分泌，但并不能达到理想的效果。3.生长抑素能明显抑制胰腺及消化道分泌，与PN合用能减少病人并发症发生率，缩短住院时间。4.应注意保护重症胰腺炎的胃肠道粘膜屏障功能，这对阻断或减轻全身炎性反应综合症有重要意义，早期少量口服谷氨酰胺是可取的，且未见增加胰腺负担，有条件者静脉给予足量谷氨酰双肽更好。5.急性胰腺炎病重期给予静脉输注血浆白蛋白十分重要，它能强化PN治疗，及时提高血浆胶体渗透压，发挥白蛋白运输和抗氧化等生理作用。6.手术病人应置空肠造瘘，以便能早期开始肠内营养，要素饮食经空肠给予无明显胰腺刺激作用。合理的营养支持加生长抑素对重症胰腺炎能改善机体营养状态，进一步减少胰腺分泌，降低重症胰腺炎的并发症，缩短住院时间。
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The effect of nutrition support with somatostatin in patients with severe pancreatitis
XU Pengyuan ,CHEN Jiayong
Abstract：Objective To evaluate the effect of Nutrtion Support with Somatostatin for patients with severe pancreantitis (Acute Hemorrhagic pancreantitis). Methods In a two years period, we selected 20 patients with severe pancreantitis, and divided them into two groups randomly. In group A (the treating group), we used TPN Plus Somatostatin, In group B (the control group) ,we just used the traditionalTPN support. All the patients in the study were diagnosed by serum amylase, ultrasound detection, CT and peritoneocentesis. Their APACH Ⅱ score were all above 9 and confirm to be severe pancreantitis. Results There was one patient died in each group, the mortality was no significant. But the occurrence of complications of group A Was decreased, and the length of in hospital was stay shortened (P<0.05). Conclusions 1. TPN could meet the hypermetabolic need of the patients with severe pancreantitis, but it was not necessary for those who just had moderate acute pancreantitis. So the APACH Ⅱ Grade was very important to condition assessment and the selection of candidates for TPN. 2. PN could improve the nutrition state of the patients with severe pancreantitis, reduce the excretion of pancreas and other digestive glands, but it could not achieve the best results for signle using. 3. Somatostatin could obviously compress the excretion of pancreas and digestive tracts, the administration of it plus PN can cut down the occurrence of complication and shorten the treating days. 4. To protect the gastric and intestind mucous barrier is crucial, it would be helpful in obstructing and alleviate the Systemic Inflammatory Response Syndrome (SIRS). We have observed that taking low-dose glutamine in early stage of severe pancreantitis didn't aggravate the burden of pancreas, and the intravenous injection of dipeptid glutamine had much better results. 5. It was also important for severe patients to be given plasma albumin by intravenous drops. It could strengthen the effect of PN, heighten the Plasmatic Colloid Osmotic Pressure, and had the effect of transportation and anti-oxidation. 6. The patients scheduled for operations had better to have jejunostomy so as to use enteral nutrtition earlier, and the elemental nutrition given through the jejunum had little stimulation to pancreas. Rational administration of TPN with somatostatin can improve the nutritional status of the patients with severe pancreantitis, decrease the excretion of pancreas and shorten the treating days., 百拇医药
单位：昆明医学院附属二院普外科 650101
关键词：
中国临床营养杂志000150摘 要：目的了解营养支持和生长抑素对重症胰腺炎的治疗作用。 方法近2年来对10例重症胰腺炎给予营养支持和生长激素治疗(治疗组)，并与早期仅用TPN支持的10例重症胰腺炎(对照组)进行比较。所有病人均经淀粉酶、B超、CT及腹腔穿刺液确诊，根据APACHEⅡ评分，>9分为重症胰腺炎。 结果两组病人各有1例死亡，差异无显著性，但治疗组并发症较少，住院时间缩短，与对照组比较差异有显著性P<0.05。 结论1.重症胰腺炎是肠外营养支持的适应证，而轻型胰腺炎可不必给予肠外营养支持，因此急性胰腺炎的临床分级是十分重要的，APACHⅡ评分能较全面地对此作出评价。2.PN能改善重症胰腺炎病人的营养状态，减少胰腺和消化液的分泌，但并不能达到理想的效果。3.生长抑素能明显抑制胰腺及消化道分泌，与PN合用能减少病人并发症发生率，缩短住院时间。4.应注意保护重症胰腺炎的胃肠道粘膜屏障功能，这对阻断或减轻全身炎性反应综合症有重要意义，早期少量口服谷氨酰胺是可取的，且未见增加胰腺负担，有条件者静脉给予足量谷氨酰双肽更好。5.急性胰腺炎病重期给予静脉输注血浆白蛋白十分重要，它能强化PN治疗，及时提高血浆胶体渗透压，发挥白蛋白运输和抗氧化等生理作用。6.手术病人应置空肠造瘘，以便能早期开始肠内营养，要素饮食经空肠给予无明显胰腺刺激作用。合理的营养支持加生长抑素对重症胰腺炎能改善机体营养状态，进一步减少胰腺分泌，降低重症胰腺炎的并发症，缩短住院时间。
, http://www.100md.com
The effect of nutrition support with somatostatin in patients with severe pancreatitis
XU Pengyuan ,CHEN Jiayong
Abstract：Objective To evaluate the effect of Nutrtion Support with Somatostatin for patients with severe pancreantitis (Acute Hemorrhagic pancreantitis). Methods In a two years period, we selected 20 patients with severe pancreantitis, and divided them into two groups randomly. In group A (the treating group), we used TPN Plus Somatostatin, In group B (the control group) ,we just used the traditionalTPN support. All the patients in the study were diagnosed by serum amylase, ultrasound detection, CT and peritoneocentesis. Their APACH Ⅱ score were all above 9 and confirm to be severe pancreantitis. Results There was one patient died in each group, the mortality was no significant. But the occurrence of complications of group A Was decreased, and the length of in hospital was stay shortened (P<0.05). Conclusions 1. TPN could meet the hypermetabolic need of the patients with severe pancreantitis, but it was not necessary for those who just had moderate acute pancreantitis. So the APACH Ⅱ Grade was very important to condition assessment and the selection of candidates for TPN. 2. PN could improve the nutrition state of the patients with severe pancreantitis, reduce the excretion of pancreas and other digestive glands, but it could not achieve the best results for signle using. 3. Somatostatin could obviously compress the excretion of pancreas and digestive tracts, the administration of it plus PN can cut down the occurrence of complication and shorten the treating days. 4. To protect the gastric and intestind mucous barrier is crucial, it would be helpful in obstructing and alleviate the Systemic Inflammatory Response Syndrome (SIRS). We have observed that taking low-dose glutamine in early stage of severe pancreantitis didn't aggravate the burden of pancreas, and the intravenous injection of dipeptid glutamine had much better results. 5. It was also important for severe patients to be given plasma albumin by intravenous drops. It could strengthen the effect of PN, heighten the Plasmatic Colloid Osmotic Pressure, and had the effect of transportation and anti-oxidation. 6. The patients scheduled for operations had better to have jejunostomy so as to use enteral nutrtition earlier, and the elemental nutrition given through the jejunum had little stimulation to pancreas. Rational administration of TPN with somatostatin can improve the nutritional status of the patients with severe pancreantitis, decrease the excretion of pancreas and shorten the treating days., 百拇医药