早期肠内营养治疗重症急性胰腺炎的作用探讨

Clinical study on the effects of early enteral nutrition in treatment of severe acute pancreatitis

目的:探讨经鼻空肠管早期行肠内营养(EN)在重症急性胰腺炎(SAP)治疗中的作用。方法:回顾分析近2年中我科收治的41例SAP病人的临床资料,按是否接受EN分成常规治疗组(20例)和EN组(21例),分析其病因,比较两组病人主要治疗经过及临床转归,APACHEⅡ评分及血清清蛋白和前清蛋白的变化。结果:41例病人全部治愈,除6例(14.63%)并发假性囊肿外,无一例因病情恶化需要手术干预。EN组病人于入院后7 d左右开始实施EN,均能较好耐受,其治疗前后APACHEⅡ分值变化显著大于常规治疗组(P<0.05)。入院3周时,血清清蛋白、前清蛋白水平均高于常规治疗组,其中前清蛋白的差异有显著性意义(P<0.05)。结论:EN支持是SAP重要治疗手段,具有可行性、安全性、易操作等特点,合理应用有助于改善病情,显著改善机体营养状况。

Objective ： To evaluate the therapeutic effects of early enteral nutrition in the treatment of severe acute pancreatitis by nasojejunal tube. Methods ： Forty-one cases of SAP were retrospectively analyzed and divided into 2 groups. There were 20 cases in conventional therapy group and 21 cases in enter- al nutrition group. Major causes, treatments and clinical results were analyzed and APACHE Ⅱ score, CT score, serum albumin and prealbumin were compared between two groups. Results： Forty-one cases were cured and no one needed surgical intervention except six pateints with pseudocysts. EN cases were fed via a nasojejunal tube placed at the seventh day after admission. EN was well tolerated throughout the course of disease. The improvement of APACHE Ⅱ score of the EN group was significantly higher than that of conventional therapy group （P 〈 0.05 ）. Serum albumin and prealbumin of the EN group were higher than that of conventional therapy group after three weeks treatment and the difference of prealbu- min was significant （ P 〈 0.05 ）. Conclusion ： As the major treatment of SAP, EN is feasible, safe and easy to use. Reasonable EN could significantly decrease the APACHE Ⅱ score and improve the nutrition status of the SAP patients.