重症急性胰腺炎早期肠内营养支持治疗

染［16］。近来，一项多中心的临床试验结果显示，应用CRAI 技术给予病人甲磺酸加贝酯和抗生素局部灌注治疗较常规应用甲磺酸加贝酯和抗生素治疗可明显缓解病人腹痛，减轻全身炎性反应，缩短病人的住院时间；同时在短时间内病人的CRP、IL-6/IL-10明显下降［17］。比较静脉和CRAI两种途径应用蛋白酶抑制剂和抗生素治疗急性胰腺炎，发现CRAI治疗可明显提高病人的累积存活率［17］。应用CT动脉造影法行动脉灌注药物治疗，使胰腺炎症部位药物浓度增高，结果发现所有受试者的APACHE II评分、CT 严重度评级均得到缓解［18］。对于重症急性胰腺炎伴非阻塞性肠系膜缺血病人，应用CRAI技术动脉灌注萘莫司他后可防止胰腺坏死［18］。目前，对于持续区域动脉灌注蛋白酶抑制剂对重症急性胰腺炎的临床治疗效果以及如何确定CRAI的最佳时间点，仍然存在争议。

8重症急性胰腺炎的血液净化治疗

在重症急性胰腺炎病程早期应用持续血液净化治疗可能阻止疾病发展至多器官功能衰竭。重症急性胰腺炎时产生的大量炎性介质入血后可导致多器官功能衰竭。血液净化治疗，特别是持续血液透析滤过（CHDF），可通过清除体液中的炎性介质，进而抑制全身炎性反应。CHDF可阻止重症胰腺炎的多器官功能障碍，并可用于腹腔内高压和腹腔间隔室综合征的治疗［19］。然而，目前尚无关于CHDF能否降低病人病死率的报道。

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（2012-05-01收稿）文章编号：1005-2208（2012）07-0533-03

重症急性胰腺炎早期肠内

营养支持治疗

李维勤

【摘要】近年来重症急性胰腺炎（severe acute pancreatitis，SAP）的营养模式发生了显著的变化，大致分为3个阶段：全胃肠外营养模式、阶段性营养支持模式和早期肠内营养

作者单位：南京军区南京总医院普通外科研究所，江苏南京210002

E-mail：liweiqindr@