分阶段营养支持对重症急性胰腺炎病人的影响

The effect of stage nutritional support on severe acute pancreatitis

目的 探讨分阶段营养支持对重症急性胰腺炎 (SAP)病人营养、免疫状态及预后的影响。方法 2 0 0 3年 4月至 2 0 0 4年 4月 ,对初次发生SAP的病人分别行分阶段营养支持 (A组 ,2 0例 )和肠外营养支持 (B组 ,2 0例 ) ,进行前瞻性对比研究。结果 A组体重、前白蛋白在发病第 16天、2 3天 ,正氮平衡例数在第 2 3天高于B组 ,P <0 0 5 ;IgG、IgM水平及CD3+ 、CD4 + 、CD4 + /CD8+ 比值在发病第 16、2 3天均高于B组 ,P <0 0 5或P <0 0 1;内毒素水平在发病第 16、2 3天均低于B组 ,P <0 0 1;APACHEⅡ评分在第 16、2 3天低于B组 ,其中转手术率、术中坏死组织细菌培养阳性率、感染性并发症发生率、平均住院费用和平均住院天数也低于B组 ,P <0 0 5。结论 分阶段营养支持对SAP病人的营养状态、免疫功能、转归和预后较肠外营养支持优势明显 ,是一种较为合理的营养方式。

Objective To study the effect of stage nutritional support on nutrition, immunity and prognosis of patients with severe acute pancreatitis. Methods Stage nutritional support (A group) and parenteral nutritional support (B group) were respectively given to the first SAP patients in a prospective compared program. Results In group A, weight and prealbumin on the 16th day and 23th day after agrouping, the number of positive nitrogen balance on the 23th day were higher than those in group B (P<0.05). The levels of IgG, IgM, CD3 +, CD4 +, and the radio of CD4 +/CD8 + on the 16th day and 23th day after agrouping were higher than those in group B (P<0.05 or P<0.01). The levels of endotoxin on the 16th day and 23th day were lower than those in group B (P<0.05). APACHEⅡ scores on 16th day and 23th day were lower than those in group B significantly and the incidence of transferred operations, the positive incidence of germiculture of necrosis tissue, the incidence of complications, the average of cost and hospital stay were lower than those in group B too (P<0.05). Conclusion Stage nutritional support is superior to parenteral nutrition on nutrition, immunity and prognosis of SAP patients significantly, and is a more reasonable nutritional mode.