Abou-Assi Souheil, O'Keefe Stephen J D
Virginia Commonwealth University Health System, Richmond, Virginia, USA.
Nutrition. 2002 Nov-Dec;18(11-12):938-43. doi: 10.1016/s0899-9007(02)00991-7.
Studies have shown that protein catabolism increases by 80% and energy expenditure by 20% in acute pancreatitis, indicating that nutritional requirements are elevated. Other studies have associated the resolution of negative nitrogen balance by nutrition support with improved outcome. Consequently, the need for effective nutrition is one cornerstone of management of acute pancreatitis. Concerns that feeding may exacerbate the disease process by stimulating the synthesis of proteolytic enzymes in the acinar cell and perpetuating autolysis has led to the widespread use of total parenteral nutrition (TPN) and bowel rest. Unfortunately, the use of TPN in clinical practice has been associated with major metabolic and infective complications, possibly because 1). patients with acute pancreatitis are intolerant of glucose due to coexistent pancreatic endocrine dysfunction and 2). the disease causes immune suppression. This has led to the search for alternatives. Based on physiologic studies, infusion of nutrients into the distal jejunum bypasses the stimulatory effect of feeding on pancreatic secretion. Many controlled trials have compared TPN with jejunal feeding. No study has shown that jejunal feeding exacerbates the disease. Further, jejunal feeding is associated with fewer infectious and metabolic complications. These observations and the fact that enteral feeding is one-tenth the cost of TPN has resulted in the general acceptance of jejunal feeding as the preferred mode for maintaining nutrition in patients with acute pancreatitis.
研究表明,急性胰腺炎时蛋白质分解代谢增加80%,能量消耗增加20%,这表明营养需求升高。其他研究将营养支持纠正负氮平衡与改善预后联系起来。因此,有效的营养支持是急性胰腺炎治疗的基石之一。担心进食可能通过刺激腺泡细胞中蛋白水解酶的合成并使自溶持续存在而加重疾病进程,导致全胃肠外营养(TPN)和肠道休息的广泛应用。不幸的是,临床实践中使用TPN与主要的代谢和感染并发症相关,可能原因如下:1)急性胰腺炎患者由于并存胰腺内分泌功能障碍而不耐受葡萄糖;2)该疾病导致免疫抑制。这促使人们寻找替代方法。基于生理学研究,将营养物质输注到空肠远端可避免进食对胰腺分泌的刺激作用。许多对照试验比较了TPN和空肠喂养。没有研究表明空肠喂养会加重疾病。此外,空肠喂养相关的感染和代谢并发症较少。这些观察结果以及肠内喂养成本仅为TPN的十分之一这一事实,使得空肠喂养成为维持急性胰腺炎患者营养的首选方式并被广泛接受。