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頁籤選單縮合
題名 | The Role of Total Parenteral Nutrition in Management of Acute Pancreatitis=全靜脈營養對治療胰臟炎之重要性 |
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作 者 | 莫景棠; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 26:3 民82.05-06 |
頁次 | 頁1737-1743 |
分類號 | 416.248 |
關鍵詞 | 全靜脈營養治療; 胰臟炎; Pancreatitis; TPN; |
語文 | 英文(English) |
中文摘要 | 在過去六年,共有454位急性胰臟炎病人。其中87位曾接受全靜脈營養治療(TPN),佔全部病人的19.2%。平均接受TPN 27天。Ranson's score平均為2.8;其中超過3的佔5l.3%;併發感染的病人在統計上偏高為4.0。死亡率為22%;主要原因是多重器官衰竭與敗血症。TPN不止可維持病人的體重與營養狀況,且可減少胰臟分泌與死亡率。急性胰臟炎病人對葡萄糖注射之接受性良好,只有34%病人因血糖較高需要添加胰島素,胰島素的平均需要量為46單位。83%病人接受每天50克脂肪乳劑注射而無血中脂肪偏高現象,證明急性胰臟炎可使用脂肪乳劑。TPN治療使用過早,並無優點反而會增加感染機會與增加很多不必要的投與。故此最佳投與時機乃是診斷確定、嚴重程度已知、且病人需使用TPN之時。雖然急性胰臟炎病人對TPN接受良好,但我們仍要盡早恢復病人之腸胃道營養以期快速復原與減少併發症之發生。 |
英文摘要 | Four hundred and fifty-four patients with acute pancreatitis were treated, between 1985 and 1990, in the Veterans General Hospital. A retrospective analysis was performed on 87, or 19.2%, of these patients who had received total parenteral nutrition (TPN) therapy. The mean time of TPN administration was 27±3 days. Ranson's scores were higher than three in 51.3% of the patients, with a mean Ranson's score of 2.8±0.2; the score was significantly higher in the infected group (4.0±0.3). Body weight and serum albumin concentration were maintained after giving TPN therapy. Tolerance of infusion of dextrose solution was good. Only 34% of the patients needed exogenous insulin because of hyperglycemia and the mean dosage of insulin replacement was 46±5 units per day. Fat emulsion was well tolerated in acute pancreatitis. Eighty-three percent of the patients received a daily infusion of 50 grams of fat emulsion, with no elevation of triglyceride levels. The mortality rate was 22%. Sepsis and multiple organ failure caused 84% of the deaths. Early TPN therapy is not beneficial. It is better to begin TPN when diagnosis has been confirmed, the severity of the disease is known and the patient definitely needs such treatment. Although patients with acute pancreatitis tolerate TPN well, early restoration of enteral nutrition is still the goal. |
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