早期空肠内营养联合中药肠内滴注对重症急性胰腺炎患者肠麻痹的改善作用

Early enteral nutrition combined with enteral infusion of traditional Chinese medicine improves intestinal paralysis in patients with severe acute pancreatitis

目的:评价早期空肠内营养联合中药加味大承气颗粒肠内滴注治疗对改善重症急性胰腺炎患者肠麻痹的作用,探索重症急性胰腺炎的中西医结合治疗的新途径.方法:39例重症急性胰腺炎患者在常规治疗基础上,随机分成3组分别进行全胃肠外营养(PN组)、早期肠内营养(EN组)、肠内营养+中药大承气颗粒(EN+中药组)肠内滴注,观察患者腹痛腹胀缓解时间、胃肠道功能恢复(肠鸣音出现、肛门排气及排便)时间,并动态监测血淀粉酶、高敏C反应蛋白(CRP)、血浆肿瘤坏死因子-α(TNF-α).结果:EN组、EN+中药组患者经治疗后腹痛腹胀症状均缓解或消失,胃肠道功能恢复正常.PN组12例中,有2例腹胀、肠麻痹持续加重,其中1例出现腹腔隔室综合征并发多脏器功能衰竭.EN组、EN+中药组在腹胀(d)、腹痛缓解时间(d)以及胃肠道功能恢复时间(d)均优于PN组(4.22±0.94,3.02±0.75vs5.72±1.55;4.66±1.14,3.14±0.62vs6.81±1.81;3.42±0.82,3.21±0.88vs6.04±1.67,均P<0.05),其中EN+中药组腹胀(d)、腹痛缓解时间(d)优于EN组(3.02±0.75vs4.22±0.94;3.14±0.62vs4.66±1.14,均P<0.05),胃肠道功能恢复时间EN组与中药组无明显差异.治疗第5天后EN+中药组血清淀粉酶(U/L)较其他两组下降更加明显(92.30±19.43vs164.35±32.10,242.35±46.20,均P<0.05);三组患者TNF-α、CRP水平均随时间而呈下降趋势,EN+中药组TNF-α(μg/L)在第5、9天下降与PN组有明显差异(1.88±0.17vs2.64±0.21,1.05±0.12vs1.98±0.16,均P<0.05),但与EN组相比无明显差异.EN+中药组CRP(mg/L)在第5、9天下降与PN组、EN组均有明显差异(24.30±12.53vs62.64±28.55,42.10±25.12;10.24±4.06vs24.98±7.14,21.01±6.46,均P<0.05).结论:早期肠内营养联合加味大承气颗粒经空肠内滴注治疗重症急性胰腺炎,能明显降低血淀粉酶及血浆TNF-α、CRP水平,有效地缓解患者的腹痛腹胀症状,促进胃肠道功能恢复正常,减轻中毒性肠麻痹,防止肠道功能的衰竭,疗效显著.

AIM： To evaluate whether early enteral nutrition （EN） combined with enteral infusion of traditional Chinese medicine JiaWei Dachengqi Granules improves intestinal paralysis in patients with severe acute pancreatitis.METHODS： Thirty-nine patients with severe acute pancreatitis who received conventional therapy were randomly divided into threegroups to undergo total parenteral nutrition （PN）, EN, EN plus enteral infusion of JiaWei Dachengqi Granules, respectively. The time required for relief of abdominal pain and distention and recovery of gastrointestinal functionwas measured, and dynamic monitoring of blood amylase, high-sensitivity C-reactive protein （CRP）, and tumor necrosis factor-α （TNF-α）was performed.RESULTS： In the EN and EN＋TCM groups,abdominal pain and distention were relievedor disappeared, and gastrointestinal functionreturned to normal after treatment. The time（days） required for relief of abdominal pain anddistention and recovery of gastrointestinal function were significantly shorter in the EN andEN＋TCM groups than in the PN group （4.22 ± 0.94, 3.02 ± 0.75 vs 5.72 ± 1.55; 4.66 ± 1.14, 3.14 ± 0.62 vs 6.81 ± 1.81; 3.42 ± 0.82, 3.21 ± 0.88 vs 6.04 ± 1.67; all P 0.05）. In contrast, in the PN group, abdominal distension and intestinal paralysis were still seen in two patients, and abdominal compartment syndrome with multiple organ failure in one patient. The concentrations of serum amylase （U/L）, TNF-α （μg/L）, and CRP （mg/L） in the EN＋TCM group decreased significantly faster than in the other two groups after 5days of treatment （serum amylase： 92.30 ± 19.43 vs 164.35 ± 32.10, 242.35 ± 46.20; TNF-α： 1.88 ± 0.17 vs 1.92 ± 0.11, 2.64 ± 0.21; CRP： 24.30 ± 12.53 vs 62.64 ± 28.55, 42.10 ± 25.12）.CONCLUSION： Early enteral nutrition combined with enteral infusion of JiaWei Dachengqi Granules improves intestinal paralysis in patients with severe acute pancreatitis possibly by reducing blood levels of amylase, TNF-α and CRP, relieving abdominal pain and distension, and promoting recovery of gastrointestinal function.