重症急性胰腺炎患者早期肠内营养的应用研究

Early Enteral Nutrition in the Treatment of Severe Acute Pancreatitis

背景:传统全胃肠外营养(TPN)对重症急性胰腺炎(SAP)的疗效不理想,早期肠内营养(EN)在SAP治疗中的作用越来越受到重视。目的:探讨早期EN在SAP治疗中的作用。方法:35例SAP患者随机分为TPN组(18例)和肠外营养(PN)+EN组(17例),比较两组治疗前后生化指标、APACHEⅡ评分和临床指标的差异。结果:治疗2周后,PN+EN组C反应蛋白和APACHEⅡ评分较治疗前和TPN组治疗后显著下降(P<0.05),血清白蛋白水平较治疗前和TPN组治疗后显著升高(P<0.05)。PN+EN组的感染率、并发症发生率、手术干预率、平均住院天数和平均住院费用均显著低于TPN组(P<0.05),两组死亡率无显著差异。结论:早期EN在SAP的治疗中起重要作用,只要条件允许,应尽早开始EN。

Background： The effect of traditional total parenteral nutrition （TPN） in the treatment of severe acute pancreatitis （SAP） is not ideal and early enteral nutrition （EN） has received much more attention than in the past. Aims： To investigate the effect of early EN in the treatment of SAP. Methods： Thirty-five patients with SAP were randomly divided into TPN group （18 patients） and parenteral nutrition （PN）＋EN group （17 patients）. Biochemical parameters, APACHE Ⅱ score before and after the two-week therapy as well as the clinical parameters between the two groups were compared. Results： After 2 weeks therapy, the level of C-reactive protein and APACHE Ⅱ score in PN＋EN group decreased obviously and were lower than those in TPN group （P〈0.05）, the serum albumin level increased markedly and was higher than that in TPN group （P〈0.05）. The incidences of infection, complication, surgical intervention, and the mean length and cost of hospital stay in PN＋EN group were significantly lower than those in TPN group （P〈0.05）. No significant difference was found in the mortality rate between the two groups. Conclusions： Early EN plays an important role in the treatment of SAP. EN should be used as early as possible in patients with SAP.