急性胰臟炎病患使用靜脈營養照護之個案分析探討

The Case Analysis of Acute Pancreatitis with Parenteral Nutririon Care

急性胰臟炎臨床前期之治療以禁食、矯正體液電解質保守治療為首要。然持續嚴重的病情不但會導致營養惡化,多重炎症反應甚至演變成敗血症。本院統計2010年1月-12月期間會診營養支持小組,使用靜脈營養的個案有9位,約佔7%。本研究所探討之個案為中年男性,初次診斷急性胰臟炎,平日飲食正常並有喝酒習慣,因手術後預計禁食數日;臨床藉由營養不良通用篩檢工具篩檢出高度營養風險、主觀性整體評估表為嚴重營養不良,營養診斷確立為預期熱量攝取不足。術後初期禁食,完全由靜脈營養給予熱量,之後逐漸由鼻胃管灌食葡萄糖水、預解元素配方飲食增加熱量,結果營養改善也高達78%。由本案例討論可知,適時量身訂製營養治療策略給予週邊靜脈營養,依據個案病程進展逐漸由靜脈營養轉換成腸道營養,能有效協助病患恢復健康。

Clinical treatment of patients suffering from acute pancreatitis at the early stage should include conservative therapies such as fasting and corrective electrolytes. However, continuation of serious illness may not only lead to nutritional deterioration but also result in multiple inflammatory reactions or even septicemia. Statistics released by the nutrition support team (NST) at Chang Bing Show Chwan Memorial Hospital, for the 12-month period in 2010, indicate that 9 patients adopted parenteral nutrition treatment, representing 7% of all patients suffering from acute pancreatitis. In my research, a middle-aged male patient participating in this study was diagnosed initially with acute pancreatitis. He had a normal diet and drank alcohol regularly but was expected to fast for a few days after the surgery. Clinical assessment using a malnutrition universal screening tool (MUST) revealed a high nutritional risk for this patient who was also diagnosed as having severe malnutrition following the application of the subjective global assessment (SGA) of nutritional status. The predicted suboptimal energy intake was confirmed after undertaking nutrition diagnosis. Due to fasting after the early stage of surgery, all energy and nutrient needs were supplied to the body intravenously in the beginning. Then, dextrose and an elemental diet were gradually fed through the nasogastric tube. His nutrition problem improved to 78%. The results of the study demonstrate that the use of peripheral intravenous nutrition or parenteral nutrition can be gradually replaced by the use of enteral nutrition, depending on the progression of patients as well as through appropriate personalized nutritional therapies and strategies, which can help patients return to a proper state of health.