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目的:观察无脂肠内营养(EN)在治疗重症急性胰腺炎(SAP)乳糜腹水的效果。方法:回顾分析5例SAP并发乳糜腹水病人的治疗。5例病人在罹患SAP后,腹部CT提示腹腔积液,予B超引导下穿刺或手术引流,引流液为乳白色,乳糜试验阳性,诊断为乳糜腹水。5例病人均首先给予无脂EN,成分为水解蛋白质粉5.2~7.8 g/(kg.d)能量[104.6~146.4 kJ(25~35 kcal)/(kg.d)]。监测腹水引流量及其三酰甘油浓度和乳糜试验的变化。结果:5例病人应用无脂EN治疗后,短时间内腹水乳糜试验即转为阴性,三酰甘油浓度显著下降,引流量逐渐减少,4例病人治愈,但1例于1个月后又出现乳糜腹水,再次给予无脂EN治疗11 d,无效,于第12天开始给予全肠外营养(TPN)联合生长抑素治疗,15 d后腹水消失;另1例病人经无脂EN治疗27 d后腹水未消退,遂改用TPN联合生长抑素治疗12 d后治愈。结论:无脂EN是治疗SAP并发乳糜腹水的一种有效方法。
Objective: To observe the effect of fat-free enteral nutrition (EN) on chylous ascites in patients with severe acute pancreatitis (SAP). Methods: Retrospective analysis of 5 cases of SAP patients with chylous ascites treatment. 5 patients with SAP, abdominal CT showed abdominal fluid, under the guidance of B-puncture or surgical drainage, drainage fluid was milky white, chyle test was positive, diagnosis of chylomicrillar ascites. All 5 patients were given fat-free EN and the energy of hydrolyzed protein powder was 5.2-7.8 g / (kg · d) [104.6-146.4 kJ (25-35 kcal) / (kg · d)]. Changes in ascites drainage and triglyceride concentrations and chylomicron test were monitored. Results: After treatment with fat-free EN in 5 patients, the ascites chill test turned negative, the triglyceride concentration decreased significantly, and the drainage volume decreased gradually. Four patients were cured, but one patient appeared again after one month Chylous ascites, again treated with fat-free EN for 11 days, was ineffective. Total parenteral nutrition (TPN) combined with somatostatin was given on the 12th day, and ascites disappeared after 15 days. Another case was treated with lipid-free EN for 27 days After ascites did not subside, then switch to TPN combined somatostatin treatment after 12 days cured. Conclusion: Fat-free EN is an effective method for the treatment of chylous ascites complicated with SAP.