早期肠内营养联合肠屏障保护合剂对重症急性胰腺炎肠屏障功能的影响

Influence of early enteral nutrition combined with gut barrier protection mixture on gut barrier function of patients with severe acute pancreatitis.

目的初步探讨持续性早期肠内营养(enteralnutrition,EN)联合肠屏障保护合剂对重症急性胰腺炎(severeacutepancreatitis,SAP)患者肠屏障功能障碍的影响。方法选择10例SAP患者,入院后48-72h后经空肠予以持续性肠内营养配合常规治疗,观察患者一般情况、腹部症状及体征并行APACHE-Ⅱ评分。治疗前及治疗后每隔1周检测血清淀粉酶、白蛋白、转铁蛋白、CRP、肿瘤坏死因子-α、白介素-1β及血浆内毒素、D-乳酸(D-lactate)、二胺氧化酶(diamineoxidase,DAO)浓度。治疗前及治疗后每隔1周予SAP患者肠通透性测试液(内含乳果糖2g、甘露醇1g)后,留取6h尿液,检测尿液乳果糖／甘露醇比值。每隔2周行腹部CT扫描复查胰腺形态学变化。治疗前及治疗后每隔1周留取粪便,提取粪便总DNA,获得反映肠道菌群组成特征的(enterobacterialrepetitiveintergenicconsensus,ERIC)指纹图谱。结果(1)10例患者都能较好地耐受肠内营养的实施,无人发生腹胀、腹泻、呕吐等不良反应。除1人有糖尿病史而发生酮症酸中毒外,无人发生高血糖及高脂血症。(2)患者APACHE-Ⅱ评分逐渐下降,CT扫描显示胰腺组织坏死区域范围显著缩小,胰周渗出吸收明显。1例患者在疾病后期因胰腺组织感染而行手术治疗,其余患者无人发生胰腺及胰外组织感染。

Objective To evaluate the influence of early enteral nutrition (EN) combined with the use of gut barrier protection mixture on gut barrier function of patients with severe acute pancreatitis (SAP). Methods Ten SAP patients received EN combined with the use of gut barrier protection mixture through a nasoenteric tube placed to the distal to the ligament of Treitz. EN was started within 48 - 72 h admission to hospital. Safety was assessed by clinical course of disease, laboratory findings including serum amylase, LDH, CRP, gut barrier function, endotoxin transloca- tion, CT scan of pancreas, and morbidity. The total DNA of microbial communities in patients' fecal samples was amplified by using the ERIC primers to generate community fingerprints. Results Enteral feeding was well tolerated throughout the course of disease. One patient developed hyperglycemia. Another patient was managed surgically because of pancreatic infection. The levels of plasma D-(-)-Lactate, diamine oxidase(DAO)and endotoxin, serum amylase, IL-1β and TNF-α decreased during the course(P < 0. 05). The levels of albumin and transgerrin increased (P < 0. 05). The urinary L/M ratio decreased gradually after treatment (P 0. 05). The makeup and distribution of intestinal microbial communities were similar during the course. Conclusions EN can improve gut metabolism, and assist in the maintenance of gut barrier function in SAP. Also, EN can decrease endotoxin translocation. It should prove to be safe and applicable for most patients.