阶段性营养支持在重症急性胰腺炎治疗中的应用

Influences of staged enteral and parenteral nutrition in patients with severe acute pancreatitis

目的观察肠内和肠外联合阶段性营养对重症急性胰腺炎治疗效果的影响。方法重症急性胰腺炎患者50例分为完全胃肠外营养组(TPN组,n=25)和肠内营养加肠外阶段性营养组(PN+EN组,n=25),比较两组治疗效果及临床指标的变化。结果两组患者治疗后血淀粉酶均有下降,但两组间比较无显著性差异(P>0.05)。营养支持后PN+EN组在APACHEⅡ评分和CT评分较TPN组明显降低(P<0.01),两组血清白蛋白及血钙水平较治疗前升高(P<0.01),血糖明显降低(P<0.01),但两组间比较无显著性差异(P>0.05)。与TPN组相比,PN+EN组患者住院天数、腹胀缓解时间、体温恢复正常时间均明显缩短,感染发生率显著降低(P<0.01)。结论肠内和肠外联合阶段性营养对重症急性胰腺炎治疗效果优于完全胃肠外营养。

Objective To evaluate the influences of combined application of staged enteral and parenteral nutrition in patients with severe acute pancreatitis. Methods Fifty patients with severe acute pancreatitis were randomly divided into two groups： total parenteral nutrition group （TPN, n = 25） and staged enteral and parenteral nutrition group （PN ＋ EN, n = 25）. The changes of clinical results between two groups were recorded. Results The serum amylase in both groups were found decreased, but there was no significant difference between two groups （P 〉 0.05）. After two weeks of nutritional support, the APACHE Ⅱ score, and CT score in PN ＋ EN group were significantly lower than those in TPN group （P 〈 0.05 ） , the blood calcium and serum albumin were significantly increased, and the blood glucose was significantly decreased （P 〈 0.01 ） , but no significant difference was found between two groups （P 〉 0.05）. Compared with TPN group, the average hospital stay was significantly shorter in PN ＋ EN group, the days of swollen relief , the rate of infection complications and the time of body temperature recoved to normal temperature were all significantly decreased （P 〈 0.01 ）. Conclusion The treatment effect of staged enteral and parenteral nutrition support is better than total parenteral nutrition support in patients with severe acute pancreatitis.