三腔喂养管在重症急性胰腺炎治疗中的应用评价

Evaluation of Application of Three-lumen Gastrojejunal Tube in the Treatment of Severe Acute Pancreatitis

背景:肠内营养一直是重症急性胰腺炎(SAP)治疗的研究热点,如何选择有效的肠内营养方式以提高患者耐受性值得探讨。目的:探讨经三腔喂养管同时行胃肠减压和早期肠内营养对SAP的治疗价值。方法:43例SAP患者随机分为治疗组(n=22)和对照组(n=21),对照组予胃肠减压管和螺旋型鼻空肠管,治疗组置入三腔喂养管。两组均予胃肠减压并在入院后48h内行早期肠内营养。比较两组的置管成功率、耐受性、胃液引流量以及血清淀粉酶、白细胞计数、C-反应蛋白等恢复正常的时间、血清白蛋白水平和肠道功能恢复正常的时间。结果:治疗后,治疗组置管成功率、耐受性、胃液引流量、肠道功能恢复正常的时间均显著优于对照组(P<0.05),两组血清淀粉酶、白细胞计数、C-反应蛋白恢复正常的时间无显著差异,血清白蛋白水平差异亦无统计学意义。结论:在SAP的治疗过程中,以三腔喂养管行胃肠减压和早期肠内营养,具有置管成功率高、耐受性好、胃液引流量大等优点,并有利于肠道功能的恢复。

Background： Enteral nutrition is constantly the hot spot of study in the treatment of severe acute pancreatitis （SAP）. It＇s worth to approach how to select the effective enteral nutrition mode in order to raise tolerance of patients. Aims： To approach the therapeutic value of gastrointestinal decompression and early enteral nutrition through three-lumen gastrojejunal tube on SAP. Methods： Forty-three patients with SAP were randomly divided into control group （n=21） and treatment group （n =22）. Patients in control group were given gastrointestinal decompression tube and spiral type nasojejunal tube. Patients in treatment group were given three-lumen gastrojejunal tube. All patients were given gastrointestinal decompression, and early enteral nutrition within 48 hours after admission. In the two groups, the success rate of tube insertion, tolerance, quantity of gastric juice draining, and time to recovery of serum amylase, white blood count, C-reactive protein and intestinal function were compared. Serum albumin level was also measured. Results： After the treatment, the success rate of tube insertion, tolerance and quantity of gastric juice draining in treatment group were significantly higher than those in control group （P〈0.05）. The time to recovery of intestinal function in treatment group was significantly shorter than that in control group （P〈0.05）. No significant differences were found in the time to recovery of serum amylase, white blood count, C-reactive protein between the two groups. The difference of serum albumin was not of statistical significance. Conclusions： In the treatment of SAP, gastrointestinal decompression and early enteral nutrition through three-lumen gastrojejunal tube can effectively increase the success rate of tube insertion, improve tolerance, increase quantity of gastric juice draining and shorten the time to recovery of intestinal function.