Pancreatitis認識胰臟炎(二)


東港安泰醫院 黃渼媄藥師

◎Special consideration

*25%以上的病患會?發pseudocystes(假孕)intestinal & pancreatic fistula(?管)

*Pancreatic abscess(膿瘍)及pancreatic ascites(腹水),這些併發症會使EN進行困難。當病患有這些併發症時需考慮使用PN。AP病患可否使用lipid emmulsions?

*大部分病患可耐受glucose及lipid based formulas,但血中TG濃度>400mg/dl時需hold。無脂肪輸液之PN不建議使用>兩週以上,易造成必須脂肪酸之缺乏。

◎Drug Point System

* Pancreatin---DONNAZYME

* Dosage of Adult

* Pancreatic insufficiency:2 tablet(1000mg) or ally with each meal and 2 tablets

* taken with food eaten between meals

* Pancrelipase---

* Dosage of Adult

* 8000-32000 lipase USP units Orally taken per Meal or snack(點 心)。

◎Treatment

急性胰臟炎--- Supportive treatment

* Narcotic analgesics usually are necessary for pain relief.最常使用Meperidine because it has no significant effect on the sphincter of Oddi。病患需禁食,直到不再疼痛和nausea。H2-recepter antagonist may be needed in severely ill patients with significant risk factors for stress ulcer bleeding。

◎Treatment

慢性胰臟炎---嚴重的劇痛,通常需要用到Narcotics,但是也有成癮性的問題。

* 口服補充pancreatic enzyme 可能有益於控制疼痛。

* 病患有intractable(難治癒的) pain 可考慮外科手術處理。

◎參考文獻

The Washington Manual Of Medical Therapeutics 29th Edition

* MICROMEDEX(R) Healthcare Series Vol.

* A.S.P.E.N. BOARD OF DIRECTORS


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