营养支持在重症急性胰腺炎中的研究治疗进展
Research and Treatment Progress of Nutritional Support in Severe Acute Pancreatitis
摘要: 急性胰腺炎是较为常见的外科急腹症，起病急，病情变化快，大多数病例(80%)预后良好。然而，20%的急性胰腺炎患者易发展为重症急性胰腺炎，重症急性胰腺炎(SAP)的特点是处于高代谢和高蛋白分解的状态，在这种情况下，营养支持是管理的基石之一。肠内营养被认为是首选营养方式，一般建议在入院后24~72小时内开始肠内营养支持。鼻胃(NG)和鼻空肠(NJ)喂养都是治疗重症急性胰腺炎可行的肠内营养(EN)方案。近年来，免疫营养、肠道菌群移植也被逐渐被视为是重症胰腺炎治疗的新方式。本文旨在综述急性胰腺炎营养支持治疗方面研究进展及目前面临的挑战。
Abstract: Acute pancreatitis (AP) is a common surgical acute abdomen with acute onset and rapid changes. Most cases (80%) have a good prognosis. However, 20% of patients with acute pancreatitis are prone to develop into severe acute pancreatitis (SAP), which is characterized by a state of hypermetabolism and protein breakdown. In this case, nutritional support is one of the cornerstones of management. Enteral nutrition is considered to be the preferred mode of nutrition, and it is generally recommended to start enteral nutrition support within 24 to 72 hours after admission. Both nasogastric (NG) and nasojejunal (NJ) feeding are feasible enteral nutrition (EN) regimens for the treatment of severe acute pancreatitis. In recent years, immunonutrition and intestinal flora transplantation have also been gradually regarded as new methods for the treatment of severe pancreatitis. This article aims to review the research progress and current challenges in nutritional support therapy for acute pancreatitis.
文章引用：王娅丽, 段降龙. 营养支持在重症急性胰腺炎中的研究治疗进展[J]. 临床医学进展, 2025, 15(4): 2173-2179. https://doi.org/10.12677/acm.2025.1541167

参考文献

[1] Leppäniemi, A., Tolonen, M., Tarasconi, A., Segovia-Lohse, H., Gamberini, E., Kirkpatrick, A.W., et al. (2019) 2019 WSES Guidelines for the Management of Severe Acute Pancreatitis. World Journal of Emergency Surgery, 14, Article No. 27. [Google Scholar] [CrossRef] [PubMed]
[2] Matta, B., Gougol, A., Gao, X., Reddy, N., Talukdar, R., Kochhar, R., et al. (2020) Worldwide Variations in Demographics, Management, and Outcomes of Acute Pancreatitis. Clinical Gastroenterology and Hepatology, 18, 1567-1575.e2. [Google Scholar] [CrossRef] [PubMed]
[3] van Geenen, E.J.M., van der Peet, D.L., Bhagirath, P., Mulder, C.J.J. and Bruno, M.J. (2010) Etiology and Diagnosis of Acute Biliary Pancreatitis. Nature Reviews Gastroenterology & Hepatology, 7, 495-502. [Google Scholar] [CrossRef] [PubMed]
[4] 中华医学会外科学分会胰腺外科学组. 中国急性胰腺炎诊治指南[J]. 浙江实用医学, 2021, 21(6): 511-521.
[5] De Lucia, S.S., Candelli, M., Polito, G., Maresca, R., Mezza, T., Schepis, T., et al. (2023) Nutrition in Acute Pancreatitis: From the Old Paradigm to the New Evidence. Nutrients, 15, Article 1939. [Google Scholar] [CrossRef] [PubMed]
[6] Pei, Z. and Tian, M. (2024) The Cgas-Sting Pathway as a Novel Therapeutic Strategy for Pancreatic Diseases. Cytokine, 184, Article 156801. [Google Scholar] [CrossRef] [PubMed]
[7] Cederholm, T., Barazzoni, R., Austin, P., Ballmer, P., Biolo, G., Bischoff, S.C., et al. (2017) ESPEN Guidelines on Definitions and Terminology of Clinical Nutrition. Clinical Nutrition, 36, 49-64. [Google Scholar] [CrossRef] [PubMed]
[8] Gopi, S., Saraya, A. and Gunjan, D. (2023) Nutrition in Acute Pancreatitis. World Journal of Gastrointestinal Surgery, 15, 534-543. [Google Scholar] [CrossRef] [PubMed]
[9] Horibe, M., Nishizawa, T., Suzuki, H., Minami, K., Yahagi, N., Iwasaki, E., et al. (2016) Timing of Oral Refeeding in Acute Pancreatitis: A Systematic Review and Meta‐analysis. United European Gastroenterology Journal, 4, 725-732. [Google Scholar] [CrossRef] [PubMed]
[10] Khatua, B., Yaron, J.R., El-Kurdi, B., Kostenko, S., Papachristou, G.I. and Singh, V.P. (2020) Ringer’s Lactate Prevents Early Organ Failure by Providing Extracellular Calcium. Journal of Clinical Medicine, 9, Article 263. [Google Scholar] [CrossRef] [PubMed]
[11] Wu, P., Li, L. and Sun, W. (2018) Efficacy Comparisons of Enteral Nutrition and Parenteral Nutrition in Patients with Severe Acute Pancreatitis: A Meta-Analysis from Randomized Controlled Trials. Bioscience Reports, 38, BSR20181515. [Google Scholar] [CrossRef] [PubMed]
[12] Hui, L., Zang, K., Wang, M., Shang, F. and Zhang, G. (2019) Comparison of the Preference of Nutritional Support for Patients with Severe Acute Pancreatitis. Gastroenterology Nursing, 42, 411-416. [Google Scholar] [CrossRef] [PubMed]
[13] Vege, S.S., DiMagno, M.J., Forsmark, C.E., Martel, M. and Barkun, A.N. (2018) Initial Medical Treatment of Acute Pancreatitis: American Gastroenterological Association Institute Technical Review. Gastroenterology, 154, 1103-1139. [Google Scholar] [CrossRef] [PubMed]
[14] Arvanitakis, M., Ockenga, J., Bezmarevic, M., Gianotti, L., Krznarić, Ž., Lobo, D.N., et al. (2020) ESPEN Guideline on Clinical Nutrition in Acute and Chronic Pancreatitis. Clinical Nutrition, 39, 612-631. [Google Scholar] [CrossRef] [PubMed]
[15] Nakashima, I., Horibe, M., Sanui, M., Sasaki, M., Sawano, H., Goto, T., et al. (2021) Impact of Enteral Nutrition within 24 Hours versus between 24 and 48 Hours in Patients with Severe Acute Pancreatitis: A Multicenter Retrospective Study. Pancreas, 50, 371-377. [Google Scholar] [CrossRef] [PubMed]
[16] Nally, D.M., Kelly, E.G., Clarke, M. and Ridgway, P. (2014) Nasogastric Nutrition Is Efficacious in Severe Acute Pancreatitis: A Systematic Review and Meta-Analysis. British Journal of Nutrition, 112, 1769-1778. [Google Scholar] [CrossRef] [PubMed]
[17] Dutta, A.K., Goel, A., Kirubakaran, R., Chacko, A. and Tharyan, P. (2020) Nasogastric versus Nasojejunal Tube Feeding for Severe Acute Pancreatitis. Cochrane Database of Systematic Reviews, No. 3, CD010582. [Google Scholar] [CrossRef] [PubMed]
[18] Gou, S., Yang, Z., Liu, T., Wu, H. and Wang, C. (2014) Use of Probiotics in the Treatment of Severe Acute Pancreatitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Critical Care, 18, Article No. R57. [Google Scholar] [CrossRef] [PubMed]
[19] Arvanitakis, M., Ockenga, J., Bezmarevic, M., Gianotti, L., Krznarić, Ž., Lobo, D.N., et al. (2024) ESPEN Practical Guideline on Clinical Nutrition in Acute and Chronic Pancreatitis. Clinical Nutrition, 43, 395-412. [Google Scholar] [CrossRef] [PubMed]
[20] Wang, M., Shi, H., Chen, Q., Su, B., Dong, X., Shi, H., et al. (2024) Comparative Safety Assessment of Nasogastric versus Nasojejunal Feeding Initiated within 48 Hours Post-Admission versus Unrestricted Timing in Moderate or Severe Acute Pancreatitis: A Systematic Review and Meta-Analysis. BMC Gastroenterology, 24, Article No. 207. [Google Scholar] [CrossRef] [PubMed]
[21] Tenner, S., Vege, S.S., Sheth, S.G., Sauer, B., Yang, A., Conwell, D.L., et al. (2023) American College of Gastroenterology Guidelines: Management of Acute Pancreatitis. American Journal of Gastroenterology, 119, 419-437. [Google Scholar] [CrossRef] [PubMed]
[22] Malmstrøm, M.L., Hansen, M.B., Andersen, A.M., Ersbøll, A.K., Nielsen, O.H., Jørgensen, L.N., et al. (2012) Cytokines and Organ Failure in Acute Pancreatitis: Inflammatory Response in Acute Pancreatitis. Pancreas, 41, 271-277. [Google Scholar] [CrossRef] [PubMed]
[23] Swetha, K., Indumathi, M.C., Kishan, R., Siddappa, S., Chen, C. and Marathe, G.K. (2025) Selenium Mitigates Caerulein and LPS-Induced Severe Acute Pancreatitis by Inhibiting MAPK, NF-κB, and STAT3 Signaling via the Nrf2/HO-1 Pathway. Biological Trace Element Research. [Google Scholar] [CrossRef] [PubMed]
[24] Lee, P.J., Papachristou, G.I., Speake, C. and Lacy-Hulbert, A. (2024) Immune Markers of Severe Acute Pancreatitis. Current Opinion in Gastroenterology, 40, 389-395. [Google Scholar] [CrossRef] [PubMed]
[25] Mattke, J., Darden, C.M., Lawrence, M.C., Kuncha, J., Shah, Y.A., Kane, R.R., et al. (2024) Toll-Like Receptor 4 in Pancreatic Damage and Immune Infiltration in Acute Pancreatitis. Frontiers in Immunology, 15, Article 1362727. [Google Scholar] [CrossRef] [PubMed]
[26] Yong, L., Lu, Q., Liu, S. and Fan, H. (2015) Efficacy of Glutamine‐enriched Nutrition Support for Patients with Severe Acute Pancreatitis: A Meta-Analysis. Journal of Parenteral and Enteral Nutrition, 40, 83-94. [Google Scholar] [CrossRef] [PubMed]
[27] Jabłońska, B. and Mrowiec, S. (2020) The Role of Immunonutrition in Patients Undergoing Pancreaticoduodenectomy. Nutrients, 12, Article 2547. [Google Scholar] [CrossRef] [PubMed]
[28] Klek, S., Kulig, J., Sierzega, M., Szczepanek, K., Szybiński, P., Scislo, L., et al. (2008) Standard and Immunomodulating Enteral Nutrition in Patients after Extended Gastrointestinal Surgery—A Prospective, Randomized, Controlled Clinical Trial. Clinical Nutrition, 27, 504-512. [Google Scholar] [CrossRef] [PubMed]
[29] Subramani, S.S., Berg, A.C., Kral, L.A., Murad, M.H., Smith, A., Phillips, A.E., et al. (2024) Analgesia for the Treatment of Acute Pancreatitis: A Protocol for a Systematic Review and Network Meta-analysis. BMJ Open, 14, e081971. [Google Scholar] [CrossRef] [PubMed]
[30] 郭志学, 宋新梅, 刘博, 等. ω-3多不饱和脂肪酸、精氨酸和谷氨酰胺的胃肠外营养支持治疗对肝癌患者术后效果分析[J]. 河北医药, 2019, 41(6): 847-850.
[31] Yu, J., Yuan, A., Liu, Q., Wang, W., Sun, Y., Li, Z., et al. (2024) Effect of Preoperative Immunonutrition on Postoperative Short-Term Clinical Outcomes in Patients with Gastric Cancer Cachexia: A Prospective Randomized Controlled Trial. World Journal of Surgical Oncology, 22, Article No. 101. [Google Scholar] [CrossRef] [PubMed]
[32] Lei, Q., Wang, X., Xia, X., Zheng, H., Bi, J., Tian, F., et al. (2015) The Role of ω-3 Fatty Acids in Acute Pancreatitis: A Meta-Analysis of Randomized Controlled Trials. Nutrients, 7, 2261-2273. [Google Scholar] [CrossRef] [PubMed]
[33] Oláh, A., Belágyi, T., Issekutz, Á., Gamal, M.E. and Bengmark, S. (2002) Randomized Clinical Trial of Specific Lactobacillus and Fibre Supplement to Early Enteral Nutrition in Patients with Acute Pancreatitis. British Journal of Surgery, 89, 1103-1107. [Google Scholar] [CrossRef] [PubMed]
[34] Oláh, A., Belágyi, T., Pótó, L., et al. (2007) Synbiotic Control of Inflammation and Infection in Severe Acute Pancreatitis: A Prospective, Randomized, Double Blind Study. Hepatogastroenterology, 54, 590-594.
[35] Besselink, M.G., van Santvoort, H.C., Buskens, E., Boermeester, M.A., van Goor, H., Timmerman, H.M., et al. (2008) Probiotic Prophylaxis in Predicted Severe Acute Pancreatitis: A Randomised, Double-Blind, Placebo-Controlled Trial. The Lancet, 371, 651-659. [Google Scholar] [CrossRef] [PubMed]
[36] Bongaerts, G.P.A. and Severijnen, R.S.V.M. (2016) A Reassessment of the PROPATRIA Study and Its Implications for Probiotic Therapy. Nature Biotechnology, 34, 55-63. [Google Scholar] [CrossRef] [PubMed]
[37] Wan, Y., Zhu, R., Bian, Z. and Sun, T. (2021) Effect of Probiotics on Length of Hospitalization in Mild Acute Pancreatitis: A Randomized, Double-Blind, Placebo-Controlled Trial. World Journal of Gastroenterology, 27, 224-232. [Google Scholar] [CrossRef] [PubMed]
[38] 黄志杰. 益生菌制剂对重症急性胰腺炎患者临床治疗效果的Meta分析[D]: [硕士学位论文]. 南昌: 南昌大学, 2024.

为你推荐