肠内营养对重症急性胰腺炎预后的影响

Effects of Enteral Nutrition on Prognosis of Patients with Severe Acute Pancreatitis

目的探讨肠内营养对重症急性胰腺炎(SAP)预后的影响。方法选择1990年1月至2005年4月在我院接受分期营养治疗的SAP患者253例,其中154例接受全肠外营养(TPN),组成TPN组;99例同时接受肠外营养(PN)和肠内营养(EN),组成PN+EN组。比较两组患者感染率、并发症发生率、住院时间和死亡率的差异。结果与TPN组相比,PN+EN组患者的胰腺感染率(10.1%vs.14.9%,P>0.05),其他部位感染率(20.2%vs.36.4%,P<0.05),并发症发生率(40.4%vs.53.9%,P<0.05)和死亡率(17.2%vs.19.5%,P>0.05)降低,住院时间缩短[(31.61±22.85)天vs.(38.17±25.50)天,P<0.05]。结论PN和EN联合应用是SAP首选的合理营养方式。

Objective To investigate the effects of enteral nutrition on primary outcomes of patients with severe acute pancreatitis （SAP）. Methods A total of 253 patients with SAP, admitted between January 1990 and April 2005, receiving the stage nutritional support were divided into two groups, i.e. total parenteral nutrition （TPN） group and parenteral nutrition combined with enteral nutrition （ PN ＋ EN） group. While TPN group consisted of 154 patients receiving TPN therapy, PN ＋ EN group consisted of 99 patients receiving PN and EN therapy. The incidence of infections and subsequent complications, the length of hospital stay, and the mortal- ity rates were compared between these two groups. Results Compared with TPN group, PN ＋ EN group was associated with a lower incidence of pancreatitic infections and hospital mortality rates, but there was no statistically significant difference （ 10.1% vs. 14.9% ; 17.2% vs. 19.5%, respectively; P 〉 0.05）. However, the incidence of infections in other sites and the subsequent complications other than infection in PN ＋ EN group were significantly lower than those in TPN group （20.2% vs. 36.4%, P 〈 0.05 ; 40.4% vs. 53.9%, P 〈 0.05, respectively）. Also, the duration of hospital stay was significantly shorter in PN ＋ EN group （ 31.61 ± 22.85 days vs. 38.17 ± 25.50 days, P 〈 0.05 ）. Conclusion PN combined with EN may be the preferred and rational route of nutritional support in patients with SAP.