急性胰腺炎的营养治疗ppt教材课件.pptxVIP

急性胰腺炎的营养治疗 概述 肠内营养 肠内营养 肠内营养的时机 肠内营养的途径：鼻胃管与鼻肠管的选择 免疫增强型和益生菌型肠内营养 2006年以来，大量文献显示EEN可以保护肠粘膜 屏障，降低感染风险，降低死亡率 早期肠内营养 (early enteral nutrition,EEN) 肠内营养的时机 Early versus On-Demand Nasoenteric Tube Feeding in Acute Pancreatitis 0.J.Bakker,S.van Brunschot,H.C.van Santvoort,M.G.Besselink,T.L.Bollen, M.A.Boermeester,C.H.Dejong,H.van Goor,K.Bosscha,U.Ahmed Ali,S.Bouwense, W.M.van Grevenstein,J.Heisterkamp,A.P.Houdijk,J.M.Jansen,T.M.Karsten, E.R.Manusama,V.B.Nieuwenhuijs,A.F.Schaapherder,G.P.van der Schelling, M.P.Schwartz,B.W.M.Spanier,A.Tan,J.Vecht,B.L.Weusten,B.J.Witteman, L.M.Akkermans,M.J.Bruno,M.G.Dijkgraaf,B.van Ramshorst, and H.G.Gooszen,for the Dutch Pancreatitis Study Group The NEW ENGLAND JOURNAL Of MEDICIN E 质 ①APACHE-Ⅱ评分≥8 ② 改 良Glasgow评分≥ 6 ③CRP≥150mg/dl Qearly group 起病24h之内鼻胃管营养治疗 Oon demand group 起病72h之后经口进食或鼻胃管 6个月 病例选择标准 分组方法 观察终点 Early Tube Feeding Outcome (N=101) Primary composite end point.infection 30 (30) or death—no.(%) Secondary end points Infection—no.(%)广 25 (25) Infected pancreatic necrosis 9 (9) Bacteremia 17(17) Pneumonia 12(12) Death—no.(%) 11(11) Necrotizing pancreatitis —no.(%) 64(63) CT severity indexj 4±2 ICU admission after randomization 18(18) —no.(%) Mechanical ventilation —no.(%) 12(12) New-onset organ failure —no./total no.at risk (%)1 Single organ failure 26/67 (39) Persistent single organ failure 10/67 (15) Multiple organ failure 7/67(10) Persistent multiple organ failure 4/67(6) On-Demand Tube Feeding (N=104) 28 (27) 27 (26) 15 (14) 18(17) 13(12) 7 (7) 65 (62) 4±3 20 (19) 14(13) 31/73 (42) 10/73 (14) 6/73 (8) 4/73 (5) Risk Ratio (95%Cl) 1.07 (0.79-1.44) 0.97 (0.70-1.34) 0.74(0.43-1.26) 0.98 (0.68-1.43) 0.97 (0.63-1.50) 1.27 (0.85-1.89) 1.06 (0.77-1.47) 0.9