中重度胰腺炎患者应用盲插空肠营养管后营养情况及安全性观察

Nutritional status and safety of patients with moderate to severe pancreatitis after blind insertion of jejunal nutrition tube

目的观察中重度胰腺炎患者应用盲插空肠营养管后营养情况及安全性。方法收集2019年1月~2022年1月82例急性胰腺炎患者作为研究对象,使用单纯随机抽样法分为观察组(41例)和对照组(41例)。两组均给予基础治疗和肠内营养支持,观察组采用盲插空肠营养管,对照组采用内镜下置管。比较两组住院时间、肠内营养开始时间、腹痛缓解时间、经口进食恢复时间、治疗前后CT严重指数(CT severity index,CTSI)评分;比较两组治疗前后营养相关指标:身体质量指数(body mass index,BMI)、血清白蛋白、血清总蛋白;比较两组血清C反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子(tumor necrosis factorα,TNF-α)及外周血白细胞计数(white blood count,WBC);比较两组治疗前后T淋巴细胞亚群CD3^(+)、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+)比值;记录两组置管并发症发生情况及一次置管成功率。结果两组住院时间、肠内营养开始时间、腹痛缓解时间、经口进食恢复时间、治疗前后CTSI评分比较无明显差异(P>0.05);治疗后,两组BMI降低,白蛋白、总蛋白水平升高(P<0.05);治疗后,两组BMI、白蛋白、总蛋白水平比较无明显差异(P>0.05);治疗后,两组CRP、TNF-α、WBC水平降低(P<0.05);治疗后,CRP、TNF-α、WBC水平无明显差异(P>0.05);治疗后,两组CD3^(+)升高,CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)降低(P<0.05);治疗后,两组CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)比较无明显差异(P>0.05);与对照组比较,观察组置管相关并发症发生率较低(P<0.05);两组一次置管成功率无明显差异(P>0.05)。结论盲插空肠营养管与内镜指导下置入空肠营养管治疗中重度急性胰腺炎患者均可保证患者的营养支持、减轻炎症反应、促进免疫功能恢复,此外盲插空肠营养管还有利于减少置管相关并发症,具有较好的应用价值。

Objective To observe the nutritional status and safety of patients with moderate to severe pancreatitis after blind insertion of jejunal nutrition tube.Methods A total of 82 patients with acute pancreatitis were enrolled in this study from January 2019 to January 2022.They were divided into observation group(n=41)and control group(n=41)by simple random sampling.Both groups were given basic treatment and enteral nutrition support.The observation group was treated with blind insertion jejunal nutrition tube,while the control group was treated with endoscopic catheterization.The length of hospital stay,the onset time of enteral nutrition,the relief time of abdominal pain,the recovery time of oral feeding,and the CT severity index(CTSI)score before and after treatment were compared between the two groups.Nutritional indicators:body mass index(BMI),serum albumin,serum total protein were compared between the two groups before and after treatment.The serum C-reactive protein(CRP),tumor necrosis factor(TNF-α)and peripheral blood white blood cell count(WBC)were compared between the two groups.T lymphocyte subsets CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)ratio were compared between the two groups before and after treatment.The complications of catheterization and the success rate of one catheterization were recorded.Results There were no significant differences in the length of hospital stay,the onset time of enteral nutrition,the relief time of abdominal pain,the recovery time of oral feeding,and the CTSI score before and after treatment between the two groups(P>0.05).After treatment,BMI was decreased,albumin and total protein levels were increased in the two groups(P<0.05).After treatment,there were no significant differences in BMI,albumin and total protein levels between the two groups(P>0.05).After treatment,the levels of CRP,TNF-αand WBC in the two groups were decreased(P<0.05).There were no significant differences in CRP,TNF-αand WBC levels after treatment(P>0.05).After treatment,CD3^(+)was increased,CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)were decreased in the two groups(P<0.05).After treatment,there were no significant differences in CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)between the two groups(P>0.05).Compared with the control group,the incidence of catheterization related complications in the observation group was lower(P<0.05).There was no significant difference in the success rate of one catheterization between the two groups(P>0.05).Conclusion Both blind insertion of jejunal nutrition tube and endoscopic insertion of jejunal nutrition tube in the treatment of patients with moderate to severe acute pancreatitis can ensure nutritional support,reduce inflammation,and promote the recovery of immune function.In addition,blind insertion of jejunal nutrition tube is also beneficial to reduce catheter-related complications,which has good application value.