早期肠内外营养支持对急性重症胰腺炎的临床价值探讨

Clinical Value Analysis of Enteral Nutrition via A Nasojejunal Feeding Tube Placed Endoscopically and Total Parenteral Nutrition in Acute Severe Pancreatitis

目的探讨经胃镜放置鼻空肠营养管行肠内营养支持(NENE)在急性重症胰腺炎(SAP)中的临床应用价值。方法回顾性分析2003年1月—2008年1月在我院因SAP而进行NENE的SAP患者35例,选择同期行完全胃肠外营养支持(TPN)的患者35例作为对照,比较两组患者营养支持前后(营养支持4周)的血红蛋白、血清白蛋白、淋巴细胞计数、血肌酐、血胆固醇、三酰甘油、血钙及空腹血糖水平,比较两组患者的住院时间、住院费用、各种并发症和病死率的发生情况。结果在经4周的营养支持后两组患者的血红蛋白和空腹血糖水平比较,差异均有统计学意义(P<0.01);血钙、血清白蛋白、血肌酐、胆固醇、三酰甘油水平及淋巴细胞计数比较,差异均无统计学意义(P>0.05)。NENE组与TPN组患者感染、多器官功能不全、高血糖症的发生率比较,差异均有统计学意义(P<0.05)。两组患者住院时间与住院费用比较,差异均有统计学意义(P<0.01)。两组患者病死率比较,差异无统计学意义(P>0.05)。结论与TPN相比,NENE尽管不能降低SAP患者的病死率,但可显著减少各种感染、多脏器功能衰竭等并发症的发生率,缩短患者的住院时间和降低住院费用,降低疾病的严重程度和患者的经济负担,其价值更优于TPN。

Objective To analyze clinical value of enteral nutrition via a nasojejunal feeding tube placed endoscopically by comparing with total parenteral nutrition.Methods Retrospective investigated 35 patients with acute severe pancreatitis who received nasojejunal enteral nutrition endoscopically（NENE）,compared the level of hemoglobin,lymphocyte count,serum albumin,serum creatinine,serum cholesterol,serum riglyceride,serum calcium with 35 patients who received total parenteral nutrition（TPN）with the same disease before and after nutrition support for 4 weeks.Compared the length of stay in hospital,the infection rate and the incidence of complication observed the incidence of complication of enteral nutrition and its duration.Results The level of lymphocyte count and serum calcium were significant increased in two group（P0.05）,the length of stay in hospital,in NENE group were significantly decreased than those in TPN group（P0.05）,the incidence of complication in NENE group were significantly depressed than those in TPN group（P0.05）,But no difference in death rate.Conclusion Nasojejunal enteral nutrition endoscopically is safe in clinical application.Compared with TPN,NENE results in better control of the incidence of complication,and decreased the the length of stay in hospital,and the cost enteral nutrition were more beneficial than total parenteral nutrition.