大黄联合早期肠内营养在重症急性胰腺炎治疗中的意义

The effects of combination of rhubarb and early enteral nutrition on severe acute pancreatitis

目的:观察大黄联合EEN治疗重症急性胰腺炎(SAP)的疗效。方法:将73例SAP病人随机分为TPN组、EEN组和大黄联合EEN(REN)组。观察三组病人住院费用、住院时间、死亡人数、肠道功能恢复时间、APACHEⅡ评分,检测血浆降钙素原(PCT)、C-反应蛋白(CRP)、PA等,并进行比较。结果:REN组无一例死亡,EEN组死亡1例,TPN组2例;REN组病人的肠道功能恢复时间、平均住院天数和费用均低于其他两组(与TPN组比,P<0.01;与EEN组比,P<0.05)。治疗1周后,REN组APACHEⅡ评分和CRP明显下降(P<0.01);PCT阳性例数由21例下降为2例(P<0.01);TPN组PA显著上升(P<0.01)。结论:大黄联合EEN治疗SAP,能促进病人消化道功能恢复,改善病人的营养状况,降低炎性反应,缩短住院时间,减少医疗费用。

Objective：To study the effects of combination of rhubarb and early enteral nutrition on severe acute pancreatitis（SAP）. Methods：A total of 73 patients with SAP were randomly divided into one of the three groups： 21 patients treated with total parenteral nutrition（TPN） , 27 patients treated with early enteral nutrition（EEN） , and 25 patients treated with combination of rhubarb and early enteral nutrition （REN）. The hospitalization cost, length of stay, mortality, recovery time of intestinal function and score of APACHE 11 were observed. The plasma procalcitonin（PCT）, the levels of C-reactive protein（CRP） and prealbumin were detected. Results： In REN group, there was no death. There was 1 patient died in EEN group and 2 patients in TPN group. The recovery time of intestinal function in REN group was （2.49 ±0.59） days, the length of stay was （25. 13 ±4.35） days, and the hospitalization cost was （56.9±7.2） thousand yuan. They were obviously shorter than those in the other groups （ TPN group,P 〈 0.01 ;EEN group, P 〈 0.05）. In REN group, the score of APACHE Ⅱ after one-week therapy was decreased from （ 11.71 ±2.58） to （3.33 ±1.01 ） （P 〈0.01 ）, which was lower than those in the TPNand EEN groups（TPN group, P 〈 0.01 ; EEN group, P 〈 0.05 ）. In addition, the level of CRP and PCT after the one-week therapy in REN group were respectively decreased. Conclusion ： The combination of rhubarb and EEN is effective for severe acute pancreatitis（SAP）.