肠内外营养支持治疗重症急性胰腺炎的临床对比分析

Enteral versus parenteral nutrition support in patients with severe acute pancreatitis

目的对比肠内外营养支持方式对重症急性胰腺炎（SAP）患者的治疗作用，阐明肠内营养的优点。方法59例SAP患者，分为全胃肠外营养（TPN）组24例及肠内营养（EN）组35例，分别检测分析两组的营养学指标，对比观察两组的治疗效果。结果两组血清白蛋白、前白蛋白、转铁蛋白、血红蛋白治疗后与治疗前相比，均有改善（P〈0．05）；血清前白蛋白、转铁蛋白EN组与TPN组比较，差异有统计学意义（P〈0．05）。无论治疗后1周还是治疗后2周，APACHEII评分EN组均低于TPN组（P〈0．05）。EN组的胰腺胰周感染率、其他并发症发病率、经口进食时间及治疗费用均低于TPN组（P〈0．05），虽然病死率、住院天数两组间无统计学差异（P〉0．05）。结论EN可以改善SAP患者的营养状况，且具有保护肠黏膜屏障功能，减少细菌及毒素移位，调节炎症和感染反应，降低医疗费用等优点，是治疗SAP理想的营养支持方式。

Objective To compare enteral nutrition （EN） and total parenteral nutrition （TPN） in the treatment of severe acute pancreatitis（SAP） elucidate the advantage of EN. Methods Fifty-nine patients were assigned to TPN and EN groups. The nutritional index was detected, and the therapeutic efficacy was reviewed comparetively. Results After giving the nutritional support, the serum contents of albumin, prealbumin, transferrin and heamoglobin were increased obviously （ P 〈 0.05 ） ; and prealbumin, transferrin had statistical difference between the TPN and EN groups（ P 〈 0.05 ）. APACHE II score was lowered significantly in the EN group, comparing with the TPN group （ P 〈 0. 05 ）. In the EN group, complications, infection rate, food intake time, and hospitalization costs were significantly lower compared with the TPN group（P 〈 0.05 ）, although mortality rate, hospital stay days had no statistical significance （ P 〉 0.05 ）. Conclusion EN is on ideal modality of nutrition support in SAP patients, which has many advantages in improving nutritional status, preserving gut mucosa barrier, decreasing bacterium and toxin shifting, regulating inflammatory and infective response, decreasing costs in the hospital.