Dergiler / Ulusal Travma ve Acil Cerrahi Dergisi / 2008 / Cilt: 14 - Sayı: 1
Exocrine pancreas disfunction in severly traumatised patients and early enteral nutrition
- Sayfa
- 34–39
- DOI
- —
Özet
Majör travma sonras›nda yo¤un bak›m servisinde yatan ve enteral yoldan beslenen hastalarda, pankreas ekzokrin salg›lar›nda görülen de¤ifliklikleri saptamakt›r. GEREÇ VE YÖNTEM Hastalar (n=18) yo¤un bak›m ünitesinde travma sonras› 24- 36. saatlerde enteral yoldan beslenmeye bafllanarak, sonuçlar ileriye dönük olarak de¤erlendirildi. Bafllang›çta yüksek molekül a¤›rl›kl› diyetler 20 ml/sa’den (1 kcal/mL) verildi ve bu miktar aflamal› olarak 80 ml/sa’ye kadar yükseltildi. Sonras›nda bu hastalardaki enteral beslenme sonras› birinci ve ikinci fekal elastaz-1 seviyelerine bak›ld›. ‹lk defekasyondan bir gram gaita örne¤i al›narak ELISA yöntemiyle fekal elastaz-1 seviyesi belirlendi. Fekal elastaz-1 normal de¤eri >200 μg/g olarak kabul edilirken, <100 μg/g olan de¤erler ciddi pankreas ekzokrin salg› bozuklu¤u olarak de¤erlendirildi. BULGULAR Tüm hastalar sadece enteral yoldan beslendi ve beslenmeye ba¤l› gastrointestinal komplikasyonlara rastlanmad›. ‹lk labotaruvar de¤erlerinde hastalar›n %55,6’s›nda fekal elastaz-1 seviyelerinde orta ve yüksek oranda düflüfl gözlendi. ‹kinci incelemelerde ise bu oran›n %38,9 seviyelerine düfltü¤ü görüldü (p<0,01). ‹lk incelemede ortalama fekal elastaz-1 seviyesi 268,4 μg/g (median 162,1 μg/g) iken, ikinci incelemede 333,8 μg/g (median 520,2 μg/g) olarak saptand›. SONUÇ Bu araflt›rmada, travma sonras› hastalarda ciddi oranda pankreas ifllev bozuklu¤u oldu¤u, yüksek molekül a¤›rl›kl› diyetle enteral yoldan beslemenin ise kayda de¤er bir iyileflme sa¤- lad›¤› görüldü. Travma sonras›, hastalarda pankreas ekzokrin enzim seviyelerinin düflüklü¤ünün nedene yönelik araflt›rmalarla ve bunun olumlu ya da olumsuz etkilerinin yap›lacak di- ¤er çal›flmalarla desteklenmesi gerekti¤i kan›s›na var›ld›.
Abstract
We investigated exocrine pancreatic insufficiency in severely traumatised patients with enteral nutrition using the fecal elastase- 1 concentration. METHODS The fecal elastase-1 levels of critically ill patients after major trauma (n=18) were determined in a prospective study. Early enteral nutrition was started with a high molecular diet via a naso-duodenal tube, starting 24-36 hours after admission to the intensive care unit. Enteral feeding was administered continuously starting with 20 mL/h (1 kcal/mL) and advanced gradually to 80 mL/h in the next days. Stool samples from the first and second stool after beginning of the enteral nutrition were taken for determination of the fecal elastase-1. For elastase-1 analysis in a sandwich-type enzyme immunoassay (ELISA), a sample of approximately 1 g stool was taken from the first and second stool after beginning of the enteral nutrition. Elastase-1 concentration of >200 μg/g was considered as normal, whereas <100 μg/g elastase-1 was significantly low indicating a severe exocrine pancreas dysfunction. RESULTS All pat ients were fed ent erally with out rel evant feeding- associated compl ic at ions and no diarrhoea occ u rred in any pat ient. In the init ial stool pass age, 55.6% of the pat ients had moder ately or s ev erely decr e ased elast ase-1 concentrat ions. In the second stool pass age, only 38.9% of the patients showed a decrease in the elastase-1 concentrat ion (p<0.01). The aver age elast ase- concentrat ion in the first stool sample was 268.4 μg/g (med ian: 162.1 μg/g) and in the second sample 333.8 μg/g (median: 520.2 μg/g). CONCLUSION The data of this study suggests that initial exocrine pancreas insufficiency may occur in severely traumatised and critically ill patients, which improves under early enteral nutrition with polymeric enteral diets. The clinical consequences of exocrine pancreatic dysfunction in the early posttraumatic situation have to be defined.