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目的:探讨重症急性胰腺炎(SAP)病人肠内营养(EN)支持治疗中肠道不耐受的原因和防治方法。方法:回顾研究128例SAP病人行EN支持治疗出现的肠道不耐受现象。结果:使用肠内输液泵、一次性EN输注器和加热器的病人78例,5例出现肠道不耐受;未使用输注系统50例,10例出现肠道不耐受。后者肠道不耐受发生率显著高于前者。15例肠道不耐受病人中,4例改用空肠输注系统后,肠道不耐受症状消失。2例降低滴注营养液浓度后,肠道不耐受症状消失。9例病人转为手术治疗,术中发现8例伴小肠充血水肿,1例小肠部分缺血坏死。8例病人出现胰周感染,术后8例可耐受EN支持治疗。结论:在使用EN支持治疗时,常规使用空肠滴注泵、一次性EN输注器和加热器,可防治SAP病人营养支持治疗中出现的肠道不耐受症状。
Objective: To investigate the causes and prevention and treatment of intestinal enter intolerance in enteral nutrition (EN) patients with severe acute pancreatitis (SAP). Methods: A retrospective study of 128 SAP patients undergoing EN supportive therapy for intestinal intolerance. Results: There were 78 patients with enteral infusion pump, one-time EN infusion and heater, and 5 patients with intestinal intolerance. Fifty patients without infusion system and 10 patients with intestinal intolerance. The incidence of intestinal intolerance was significantly higher than the former. Of the 15 patients with intestinal intolerance, 4 were switched to the jejunal infusion system and the symptoms of intestinal intolerance disappeared. 2 cases of instillation of nutrient solution to reduce the intestinal symptoms of intolerance disappeared. Nine patients turned to surgical treatment, 8 cases were found with small bowel congestion and edema, 1 case of intestinal ischemia and necrosis. Peritival infection occurred in 8 patients, and 8 patients were tolerant to EN support after surgery. Conclusions: Jejunal instillation pumps, disposable EN injec- tors and heaters are routinely used when using EN-supported therapies to prevent intestinal intolerance in the nutritional support of SAP patients.