欧珊，张俊文（重庆医科大学附属第一医院消化内科，重庆400016）

·论著·

营养支持在重症胰腺炎后局部并发症治疗中的意义

欧珊，张俊文△
（重庆医科大学附属第一医院消化内科，重庆400016）

目的探讨肠内营养（EN）与全肠外营养（TPN）对急性重症胰腺炎（SAP）后局部并发症的影响。方法回顾性分析该院2005年12月至2015年2月收治的210例SAP后胰腺局部并发症（胰周积液、假性囊肿）患者的临床资料，按不同营养方式分为EN组［经皮内镜下胃/空肠造口（PEG/PEJ）和鼻空肠管］，以及TPN组，比较两组营养情况（清蛋白、血红蛋白、淋巴细胞）、并发症转归、病死率，以及EN组2种营养方式操作相关性并发症的发生率。结果EN组与全肠外营养组比较，淋巴细胞、清蛋白、血红蛋白均较后者增高，差异均有统计学意义（P＜0.05），出现新并发症的概率及病死率均降低，差异均有统计学意义（P＜0.05）；不同并发症中EN与TPN比较减少、完全吸收时间差异均无统计学意义（P＞0.05）；2种EN操作相关性并发症发生率比较，鼻空肠管组较经皮胃空肠造瘘术组增高，差异有统计学意义（P＜0.05）。结论SAP后局部并发症患者禁食时间较长，有效的营养支持是必要的，而EN疗效明显优于全肠外营养，其中PEG/PEJ较鼻空肠管并发症少，适合临床应用。

胃肠外营养；胰腺炎；肠道营养；胆道疾病；肠内营养

【Abstract】Objective To explore the influence of the enteral nutrition（EN）and total parenteral nutrition（TPN）on local complications in severe acute pancreatitis（SAP）.M ethods The clinical data of210 patients with local complications（peripancreatic effusion，pseudocyst）after SAP treated in our hospital from December 2005 to February 2015 were retrospectively analyzed.These cases were divided into the EN group［percutaneous endoscopic gastric/jejunum stoma（PEG/PEJ）and nasal jejunal feeding tube］and the TPN group.The nutrition situation（albumin，HGB，lymphocyte），complication outcome and mortality rate were compared between the two groups，and the occurrence rates of 2-kind nutritional mode operation associated complications were compared too.Results Compared with the TPN group，the HGB，lymphocyte and ALB levels in the EN group were increased with statistical difference（P＜0.05），the probability of new complication appearance andmortality ratewere decreased with statistical difference（P＜0.05），but the reduced and completely absorption time of different complications had no statistical differences between the EN group and the TPN group（P＞0.05）；the occurrence rate of2-kind EN operation related complications in the nasal jejunal tube group was increased compared with the gastric jejunal stoma group，the difference was statistically significant（P＜0.05）.Conclusion The patients with local complications after SAP have fasting for a long time，an effective nutrition support is necessary.The effect of EN is obviously superior to TPN，in which PEG/PEJhas little complications than nasal jejunal feeding tube and issuitable for clinicalapplication.

【Key words】Parenteral nutrition；Pancreatitis；Enteral nutrition；Biliary tract diseases；Enteral nutrition

重症急性胰腺炎（severe acute pancreatitis，SAP）是临床常见危急重症，病情凶险，随着病程进展，部分患者可出现胰腺局部并发症：急性胰周液体积聚（acutperipan creatic fluid collection，APFC）、急性坏死物积聚（acute necrotic cection collection，ANC）、包裹性坏死（walled-off necrosis，WON）、假性囊肿（pancreatic pseudocyst）［1］，其中前2种并发症在未合并感染的情况下经保守治疗、多能吸收［2］。……