早期肠内免疫营养在重症急性胰腺炎治疗中的应用

The clinical application of the early enteral nutrition in severe acute pancreatitis

目的比较免疫营养配方（EIN）与标准配方肠内营养（EN）对重症急性胰腺炎（SAP）炎症反应和患者感染预后的影响。方法所有患者均符合SAP诊断标准，APACHEII评分8分以上。随机分为两组：免疫营养组22例（研究组），给予EIN；对照组22例，给予标准型EN。共30d。两组患者的一般情况和病情严重度相似，并给予相同的处理，在发病1周左右，通过内镜放置鼻空肠管或经胃镜胃造瘘术行EIN及EN。观察全身炎症反应、营养指标的变化，比较感染等并发症发生率和病死率。结果①研究组死亡1例，对照组死亡2例；②两组的胰周感染发生率差异有统计学意义（P〈0．05）；③两组治疗前后C反应蛋白、白细胞计数均明显下降（P〈0．05），血小板计数均有所升高，差异有统计学意义（P〈0．01）；④平均住院时间两组差异有统计学意义（P〈0．05）。结论早期EIN与普通EN都能明显减轻SAP患者的炎症反应，改善营养状况，但EIN在预防SAP患者继发感染反应方面优于普通EN。

Objectives To compare the effect of early enteral immunonutrition （EIN） vs early standard enteral nutrition （EN） on the inflammatory response and prognosis of severe acute pancreati- tis. Methods A total of 44 patients complied with diagnostic code for SAP（ APACHE - Ⅱ score 〉 8）. Patients with severe acute pancreatitis were randomized into EIN group（ n =22 ） and EN group（ n = 22）. The course of treatment was 30 days. The general conditions and severity of the disease were similar in both groups. Two groups were fed via an endoscopically placed nasogastrojejunal tube or stoma within 7 days after admission. The changes in the markers of inflammatory response, cases of complication and fatality, and nutrition indicators were observed. Results （1）One inpatient died in EIN group, and 2 in EN group. （2） Infected pancreatic necrosis and abscess occurrence rate showed no significant difference between two groups. （3）There was remarkable decreases in CRP and amount of leukocytes in both groups（ P 〈 0.05 ）, while blood platelets were remarkably increased （ P 〈 0. 01 ）. （4）There was significant difference （ P 〈 0.05 ） in hospital stay between two groups. Conclusion EIN and common EN were equally effective to the patients with SAP on alleviating inflammatory response, and ameliorating nutritional state. However EIN is more efficient than the common EN in preventing secondary infection of the patients.