重症急性胰腺炎完全胃肠外营养与肠外联合肠内营养治疗对比研究

Comparision study of total parenteral nutrition and parenteral nutrition combining enteral nutrition in severe acute pancreatitis

目的 观察重症急性胰腺炎（SAP）完全胃肠外营养（TPN）与肠外营养（PN）联合肠内营养（EN）治疗中各项指标的变化,分析二者疗效.方法 29例SAP随机分为TPN组（14例）和PN＋EN组（15例）,并均行非手术治疗14 d,观察疗效及化验指标的变化.结果 营养支持治疗14 d后,各组血清白蛋白（ALB）、总蛋白（TSP）、血钙（Ca2＋）、谷丙转氨酶（ALT）、谷草转氨酶（AST） 较营养支持前均显著升高（P〈0.05）;各组血糖、血清淀粉酶、血WBC均较营养支持前显著下降（P〈0.05）;各组血总胆红素（TB）治疗前后差异无统计学意义（P〉0.05）;PN＋EN组血WBC显著低于TPN组（P〈0.05）,其余化验指标组间比较差异无统计学意义（P〉0.05）;各组APACHEⅡ评分较治疗前显著降低（P〈0.05）,PN＋EN组评分显著低于TPN组（P〈0.05）.PN＋EN组住院天数、住院总费用、感染发生率及死亡率均显著低于TPN组（P〈0.05）.结论 PN联合EN治疗SAP优于TPN.

Objective To explore the changes of indicators for total parenteral nutrition （TPN） and parenteral nutrition （PN） combining enteral nutrition （EN） support in patients with severe acute pancreatitis （SAP）, and to analyze the treatment effects of two groups. Methods 29 patients with SAP were randomly divided into two groups： TPN group （n=14） and PN＋EN group （n=15）. Nonoperative treatment were applied to the two groups. The changes of indicators and therapeutic outcome of two groups were recorded after nutrition support 14 days. Results After 14 days nutritional support, serum albumin （ALB）, total serum protein （TSP）, blood calcium, glutamic-pyruvic transaminase （ALT）, glutamic-oxaloacetic transaminase （AST） in each group increased significantly （P〈0.05）. While blood glucose, serum amylase, leucocyte count decreased significantly （P〈0.05）. However, there were no significant difference between two groups except leucocyte count in all laboratory tests. The leucocyte count in the PN＋EN group was significantly lower than that in the TPN group （P〈0.05）. In both group there was no difference found in serum total bilirubin （TB） before and after nutrition support （P〉0.05）. The APACHE II scores, average hospital days, average hospital charges, incidence of infection and mortality rate in the PN＋EN group were significantly lower than that in the TPN group （P〈0.05）. ConclusionsPN combining EN support was superior to TPN in the treatment of patients with SAP.