早期肠内营养改善急性重症胰腺炎患者术后免疫功能的研究

Improvement of immune function in patients with acute severe pancreatitis by early postoperative enteral nutrition

目的 探讨早期肠内营养在改善急性重症胰腺炎患者术后免疫功能中的作用。方法 60例急性重症胰腺炎手术患者随机分为早期肠内营养组 (研究组 )和常规治疗组 (对照组 )。分别检测研究组与对照组术后第 1天、营养支持后 1周、2周的免疫指标、营养指标和一般指标 ,并观察营养支持的效果。结果 研究组吞噬细胞功能、CD4+ T细胞、CD8+ T细胞均明显高于对照组 (P<0 .0 5 ) ,而IL -6、TNF -a水平则明显低于对照组 (P <0 .0 5 ) ,前白蛋白、白蛋白、转铁蛋白两组间差异无显著性意义 (P >0 .0 5 ) ,并发症发生率、治愈率、死亡率、平均住院时间两组间存在显著性差异 (P <0 .0 5 )。结论 早期肠内营养治疗可明显改善急性重症胰腺炎患者的免疫功能 ,减轻术后创伤的应激和炎症反应程度 ,提高临床治疗效果。

Objective To explore whether early enteral nutrition can improve immune function after operation in patients with acute severe pancreatitis.Methods A prospective,randomized,double-blind and clinical trial was performed.Sixty patients with acute severe pancreatitis subject to operations were randomly divided into two groups.One group was given a parenteral nutrition and the other was fed with early enteral nutrition.Immune and common factors were tested before nutrition support and at first and second weeks during nutrition support after operation in control and experimental groups.Clinical effects were also observed.Results The phagocytosis ability,the levels of CD 4 + T lymphocytes,CD 8 + T lymphocytes,CD 4 +/CD 8 + in experimental group were significantly higher than those in control group (P<0.05).However,the amounts of IL-2,TNF-a in experimental group were significantly lower than those in control group (P<0.05).There was no obvious difference in the levels of albumin,prealbumin and transferring metal protein between two groups (P>0.05),while there were obvious differences in the levels of the incidence of complication,mortality,the curative rate and average time of hospitalization between two group (P<0.05).Conclusion Early postoperative enteral nutrition can significantly enhance immune function in patients with acute severe pancreatitis and positively modulate the postsurgical immunosuppressive and inflammatory responses,moreover it obviously improves clinical effects of therapy.