急性胰腺炎患者胰腺外分泌功能不全识别及护理的研究进展

doi:10.3761/j.issn.0254-1769.2020.12.020

摘要/Abstract

摘要：

急性胰腺炎发病率逐年上升。急性胰腺炎后近1/3患者发生胰腺外分泌功能不全,导致患者出现消化吸收障碍、营养不良等症状。该文回顾国内外文献,对护理人员关注急性胰腺炎患者胰腺外分泌功能不全的重要性、胰腺外分泌功能不全的识别与监测、护理措施等方面进行综述,为护理人员的相关临床工作提供科学依据。

关键词: 胰腺炎, 急性, 胰腺外分泌功能不全, 预防, 护理, 综述

Abstract:

The incidence of acute pancreatitis is increasing year by year. Nearly one-third of patients develop exocrine pancreatic insufficiency after acute pancreatitis,which leads to the symptoms such as digestion disorders,absorption disorders and malnutrition. This article reviewed domestic and international literature on the importance of nursing staff’s attention to pancreatic exocrine insufficiency,and the recognition,monitoring and nursing measures of pancreatic exocrine insufficiency. It provided scientific bases for relevant clinical work of nursing staff.

Key words: Pancreatitis, Acute, Pancreatic Exocrine Insufficiency, Prevention, Nursing Care, Review

王欣然,钟丽霞,张晓雪. 急性胰腺炎患者胰腺外分泌功能不全识别及护理的研究进展[J]. 中华护理杂志, 2020, 55(12): 1871-1875.

WANG Xinran,ZHONG Lixia,ZHANG Xiaoxue. The identification and clinical nursing care of pancreatic exocrine insufficiency in patients with acute pancreatitis[J]. Chinese Journal of Nursing, 2020, 55(12): 1871-1875.

参考文献 39

[1]	Lindkvist B, Phillips ME, Domínguez-Muñoz JE. Clinical,anthro-pometric and laboratory nutritional markers of pancreatic exocrine insufficiency:prevalence and diagnostic use[J]. Pancrea-tology, 2015,15(6):589-597.
[2]	Wang DY, Tang MC, Zong PF, et al. MiRNA-155 regulates the Th17/treg ratio by targeting SOCS₁ in severe acute pancreatitis[J]. Front Physiol, 2018,9:686. URL PMID
[3]	张超, 李昂, 李非. 急性胰腺炎后胰腺外分泌功能不全患者的诊治[J]. 中华肝胆外科杂志, 2018,24(11):785-789.
	Zhang C, Li A, Li F. The diagnosis and treatment of patients with pancreatic exocrine insufficiency after acute pancreatitis[J]. Chin J Hepatobiliary Surg, 2018,24(11):785-789.
[4]	Das SL, Kennedy JI, Murphy R, et al. Relationship between the exocrine and endocrine pancreas after acute pancreatitis[J]. World J Gastroenterol, 2014,20(45):17196-17205. DOI URL PMID
[5]	Duggan SN, Smyth ND, O’Sullivan M, et al. The prevalence of malnutrition and fat-soluble vitamin deficiencies in chronic pancreatitis[J]. Nutr Clin Pract, 2014,29(3):348-354. URL PMID
[6]	《中华胰腺病杂志》编委会. 中国胰腺外分泌功能不全诊治规范(草案)[J]. 中华胰腺病杂志, 2013,13(1):45-48.
	Editorial board of Chin J Pancreatology. Chinese guideline for diagnosis and treatment of pancreatic exocrine insufficiency(draft)[J]. Chin J Pancreatol, 2013,13(1):45-48.
[7]	中国医师协会胰腺病专业委员会慢性胰腺炎专委会. 胰腺外分泌功能不全诊治规范(2018,广州)[J]. 临床肝胆病杂志, 2019,35(2):294-298.
	Special Committee on Chronic Pancreatitis,Pancreatic Disease Specialized Committee,Chinese Medical Doctor Association. Standards for the diagnosis and treatment of pancreatic exocrine insufficiency(2018,Guangzhou)[J]. J Clin Hepatol, 2019,35(2):294-298.
[8]	宋洪涛. 重症急性胰腺炎患者出院准备度及其影响因素分析[J]. 现代临床护理, 2019,18(8):9-13.
	Song HT. Discharge preparation and influencing factors of severe acute pancreatitis[J]. Mod Clin Nurs, 2019,18(8):9-13.
[9]	杨巧云. 延续护理对预防急性胰腺炎患者复发的有效性分析[J]. 中国卫生标准管理, 2016,7(4):214-216.
	Yang QY. Effectiveness of continuous nursing care for the prevention of recurrence of acute pancreatitis[J]. China Heal Stand Manag, 2016,7(4):214-216.
[10]	Hollemans RA, Hallensleben NDL, Mager DJ, et al. Pancreatic exocrine insufficiency following acute pancreatitis:systematic review and study level meta-analysis[J]. Pancreatology, 2018,18(3):253-262. URL PMID
	Sabater L, Ausania F, Bakker OJ, et al. Evidence-based guidelines for the management of exocrine pancreatic insufficiency after pancreatic surgery[J]. Ann Surg, 2016,264(6):949-958. URL PMID
[12]	中华医学会外科学分会胰腺外科学组, 中国研究型医院学会胰腺疾病专业委员会. 胰腺术后外分泌功能不全诊治的中国专家共识(2018)[J]. 中华外科杂志, 2018,56(9):641-645.
	Study Group of Pancreatic Surgery in Chinese Society of Surgery of Chinese Medical Association, Pancreatic Disease Committee of Chinese Research Hospital Association. A consensus statement on the diagnosis and treatment of pancreatic exocrine insufficiency after pancreatic surgery(2018)[J]. Chin J Surg, 2018,56(9):641-645.
[13]	Ní Chonchubhair HM, Bashir Y, Dobson M, et al. The prevalence of small intestinal bacterial overgrowth in non-surgical patients with chronic pancreatitis and pancreatic exocrine insufficiency(PEI)[J]. Pancreatology, 2018,18(4):379-385. DOI URL PMID
[14]	魏蓉娜, 崔莉红, 刘胜捷, 等. 160例胰腺外分泌功能不足患者的临床观察及其中医分型[J]. 中国中西医结合外科杂志, 2018,24(1):26-30.
	Wei RN, Cui LH, Liu SJ, et al. Clinical observation and traditional Chinese medicine classification of 160 cases of pancreatic exocrine insufficiency[J]. Chin J Surg Integr Tradit and West Med, 2018,24(1):26-30.
[15]	Nikfarjam M, Wilson JS, Smith RC. Diagnosis and management of pancreatic exocrine insufficiency[J]. Med J Aust, 2017,207(4):161-165. URL PMID
[16]	Winter Gasparoto RC, Racy Mde C, De Campos T. Long-term outcomes after acute necrotizing pancreatitis:what happens to the pancreas and to the patient[J]. JOP, 2015,16(2):159-166.
[17]	吕慧, 李山林, 周洪涛, 等. 早期肠内营养对急性胰腺炎病人内外分泌功能和远期生活质量的影响[J]. 肠外与肠内营养, 2020,27(1):33-36.
	Lü H, Li SL, Zhou HT, et al. The effects of early eternal nutrition on pancreatic endocrine/exocrine functions and long-term quality of life in acute pancreatitis patients[J]. Paren-ter Enter Nutr, 2020,27(1):33-36.
[18]	Ellery KM, Kumar S, Crandall W, et al. The benefits of early oral nutrition in mild acute pancreatitis[J]. J Pediatr, 2017,191:164-169. URL PMID
[19]	Krishnan K. Nutritional management of acute pancreatitis[J]. Curr Opin Gastroenterol, 2017,33(2):102-106.
[20]	贺文成, 郑志刚. 早期肠内营养对危重症患者胰腺外分泌功能不全的影响[J]. 中国现代医学杂志, 2019,29(4):58-60.
	He WC, Zheng ZG. Effect of early enteral nutrition on pancreatic exocrine insufficiency in critically ill patients[J]. Chin J Mod Med, 2019,29(4):58-60.
[21]	Xu L, Wang T, Chen T, et al. Identification of risk factors for enteral feeding intolerance screening in critically ill patients[J]. Saudi Med J, 2017,38(8):816-825. URL PMID
[22]	陈亭, 王婷, 李清, 等. 重症急性胰腺炎患者肠内营养喂养不耐受状况及其影响因素研究[J]. 中华护理杂志, 2017,52(6):716-720.
	Chen T, Wang T, Li Q, et al. Current status and influencing factors of enteral feeding intolerance in patients with severe acute pancreatitis[J]. Chin J Nurs, 2017,52(6):716-720.
[23]	程伟鹤, 鲁梅珊, 郭海凌, 等. 危重症患者早期肠内营养喂养不耐受的研究进展[J]. 中华护理杂志, 2017,52(1):98-102.
	Cheng WH, Lu MS, Guo HL, et al. Research progress on early enteral feeding intolerance in critically ill patients[J]. Chin J Nurs, 2017,52(1):98-102.
[24]	王春友. 急性坏死性胰腺炎治疗的历史与现状:百年探索二十年突破[J]. 中华外科杂志. 2020,58(1):9-12.
	Wang CY. History and present status of treamnt of acute necrotizing pancreatitis treatment：a century of exploration and a breakthrough of 20 years[J]. Chin J Surg, 2020,58（1）：9-12.
[25]	Tenner S, Baillie J, DeWitt J, et al. American College of Gastroenterology guideline：management of acute pancreatitis[J]. Am J Gastroenterol, 2013,108（9）：1400,1416.
[26]	王欣然, 张晓雪, 张宇, 等. 胰腺坏死感染阶梯微创手术引流管护理方案的制订及实践[J]. 中华护理杂志, 2017,52(5):571-575.
	Wang XR, Zhang XX, Zhang Y, et al. Formulation and application of drainage tube nursing program in step-up mini-invasive surgery for infected pancreatic necrosis[J]. Chin J Nurs, 2017,52(5):571-575.
[27]	王欣然, 张芝颖, 张晓雪, 等. 感染性胰腺坏死清创引流术后脓腔不灌洗患者的护理[J]. 中华护理杂志, 2019,54(4):520-522.
	Wang XR, Zhang ZY, Zhang XX, et al. Nursing care of patients with infected pancreatic necrosis without necrotic cavity lavage after debridement and drainage[J]. Chin J Nurs, 2019,54(4):520-522.
[28]	Working Party of the Australasian Pancreatic Club, Smith RC, Smith SF, et al. Summary and recommendations from the Australasian guidelines for the management of pancreatic exocrine insufficiency[J]. Pancreatology, 2016,16(2):164-180. URL PMID
[29]	Durie P, Baillargeon JD, Bouchard S, et al. Diagnosis and mana-gement of pancreatic exocrine insufficiency(PEI) in primary care:consensus guidance of a Canadian expert panel[J]. Curr Med Res Opin, 2018,34(1):25-33. DOI URL PMID
[30]	谢萍, 张灿, 王静. 健康教育对急性胰腺炎患者心理状况和健康行为能力的影响[J]. 中华护理教育, 2015,12(11):852-857.
	Xie P, Zhang C, Wang J. The impact of health education based on the health as expanding consciousness theory on psychological status and healthy behavior ability of discharged acute pancreatitis patients[J]. Chin J Nurs Educ, 2015,12(11):852-857.
[31]	Gheorghe C, Seicean A, Saftoiu A, et al. Romanian guidelines on the diagnosis and treatment of exocrine pancreatic insufficiency[J]. J Gastrointestin Liver Dis, 2015,24(1):117-123. DOI URL PMID
[32]	Trang T, Chan J, Graham DY. Pancreatic enzyme replacement therapy for pancreatic exocrine insufficiency in the 21(st)century[J]. World J Gastroenterol, 2014,20(33):11467-11485. DOI URL PMID
[33]	Struyvenberg MR, Martin CR, Freedman SD. Practical guide to exocrine pancreatic insufficiency-Breaking the myths[J]. BMC Med, 2017,15(1):29.
[34]	Luaces-Regueira M, Iglesias-García J, Lindkvist B, et al. Smoking as a risk factor for complications in chronic pancreatitis[J]. Pancreas, 2014,43(2):275-280. DOI URL PMID
[35]	Afghani E, Sinha A, Singh VK. An overview of the diagnosis and management of nutrition in chronic pancreatitis[J]. Nutr Clin Pract, 2014,29(3):295-311. DOI URL PMID
[36]	Ferrie S, Graham C, Hoyle M. Pancreatic enzyme supplementation for patients receiving enteral feeds[J]. Nutr Clin Pract, 2011,26(3):349-351. DOI URL PMID
[37]	陈虹蓉, 江方正, 吴莉莉, 等. 不同条件胰酶肠溶颗粒溶解速度研究[J]. 护理研究, 2017,31(6):698-700.
	Chen HR, Jiang FZ, Wu LL, et al. Study on dissolution speed of Creon particle in different conditions[J]. Nurs Res China, 2017,31(6):698-700.
[38]	屠冬英, 王美峰, 王玲. 护理协作模式在1例高脂血症性重症胰腺炎患者护理中的应用[J]. 中华护理杂志, 2018,53(7):890-892.
	Tu DY, Wang MF, Wang L. Application of multidisciplinary collaboration model in nursing care of patients with hyperlipidemic severe pancreatitis[J]. Chin J Nurs, 2018,53(7):890-892.
[39]	郝文女, 李晓静, 李新霞. 延续护理干预对急性胰腺炎病人复发率影响的系统评价[J]. 护理研究, 2017,31(32):4114-4118.
	Hao WN, Li XJ, Li XX. Systematic evaluation on effect of continuous nursing intervention on recurrence rate of patients with acute pancreatitis[J]. Nurs Res China, 2017,31(32):4114-4118.

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