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目的探讨老年(年龄≥60岁)重症急性胰腺炎(SAP)患者营养治疗中肠道不耐受的原因和防治。方法回顾研究2006年1月至2007年11月128例重症急性胰腺炎行空肠营养治疗出现的肠道不耐受现象。其中老年患者56例,非老年72例。结果56例老年SAP,11例出现肠道不耐受,对照组(年龄<60岁)72例,4例出现肠道不耐受;老年组肠道不耐受发生率与对照组比较差异有统计学意义。老年组肠道不耐受患者经非手术处理,5例肠道不耐受症状消失:其中3例使用肠内输液泵(flocare 800 pump)、一次性肠内营养输注器以及加热器,2例降低营养液滴注浓度。老年组6例转为手术治疗,发现5例伴小肠充血水肿,1例小肠部分缺血坏死;5例存在胰周感染,术后5例耐受肠内营养支持治疗。结论老年SAP肠内营养治疗中,肠道不耐受的发生率较高,其原因与营养液滴注速度、浓度和温度有关。老年SAP肠内营养使用过程中应特别注意肠功能障碍的发生,及时行胰腺坏死组织清创引流减压是防治肠功能障碍及恢复肠道营养治疗的重要措施。
Objective To investigate the causes and prevention and treatment of intestinal insufficiency during nutritional therapy in the elderly (aged ≥60 years) with severe acute pancreatitis (SAP). Methods A retrospective study was conducted on 128 cases of severe acute pancreatitis treated with jejunal nutrition between January 2006 and November 2007. 56 cases of elderly patients, 72 cases of non-elderly. Results 56 cases of elderly SAP, 11 cases of intestinal intolerance, the control group (age <60 years) in 72 cases, 4 cases of intestinal intolerance; intestinal obstruction in the elderly group compared with the incidence of the control group were Statistical significance. Five patients with intestinal intolerance disappeared in the elderly group of patients with intestinal intolerance: 3 of them received flocare 800 pump, disposable enteral nutrition and heaters, 2 Example to reduce nutrient droplet concentration. In the elderly group, 6 cases were switched to surgery. Five cases were found to have congestion and edema in the small intestine. One case was necrosis of the small intestine. Five cases had peripancreatic infection and 5 cases were tolerated by enteral nutrition support. Conclusion The incidence of intestinal intolerance in elderly SAP enteral nutrition therapy is high, the reason is related to the speed, concentration and temperature of instillation of nutrient solution. During the process of enteral nutrition for senile SAP, special attention should be paid to the occurrence of intestinal dysfunction. Debridement and decompression of pancreatic necrotic tissue in time are important measures to prevent and treat intestinal dysfunction and to restore enteral nutrition.