胰腺炎的营养治疗-Remy.pptVIP

* * * * * * * * * * * * Sandstrom R, Hyltander A, Korner U, Lundholm K. Structured triglycerides were well tolerated and induced increased whole body fat oxidation compared with long-chain triglycerides in postoperative patients. JPEN 19(5):381-386; 1995 Kruimel JW, Naber TH, van der Vliet JA, Carneheim C, Katan MB, Jansen JB. Parenteral structured triglyceride emulsion improves nitrogen balance and is cleared faster from the blood in moderately catabolic patients. JPEN 25(5):237-244; 2001 Lindgren BF, Ruokonen E, Magnusson-Borg K, Takala J. Nitrogen sparing effect of structured triglycerides containing both medium-and long-chain fatty acids in critically ill patients; a double blind randomized controlled trial. Clin Nutr 2001 Feb;20(1):43-48 Chambrier C, Guiraud M, Gibault JP, Labrosse H, Bouletreau P. Medium- and long-chain triacylglycerols in postoperative patients: structured lipids versus a physical mixture. Nutrition 1999 Apr;15(4):274-7 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Recommendation II There is no evidence that neither EN or PN has a clinical beneficial effect on clinical outcome in patients with mild pancreatitis, if you can predict that the patient can consume normal food in between 5 days (A) If oral nutrition is not possible in 5 days enteral nutrition should be started immetiately (C) If this is true in patients with malnutrition is not known ESPEN, Guidelines 2006/2009Treatment mild pancreatitis Assessment of severity of acute pancreatitis mild to moderate fasting (2-5 days) analgesics i.v. fluid/electrolytes no pain, enzymes↓ refeeding (3-7 days) diet rich in CH diet moderate in protein/fat normal diet ↓ ↓ ↓ ↓ ↓ Recommendation III Nutritional support in essential in patients with severe disease and nutritional risk factors (A) The route of nutrient delivery (parenteral/enteral) should be determined by the patient tolerance EN should be attempted in all patients first (C) Inta