早期肠内营养对重症急性胰腺炎疗效的影响

Curative effect of early enteral nutrition for severe acute pancreatitis

目的探讨早期肠内营养对重症急性胰腺炎（SAP）患者的疗效的影响。方法收集58例SAP患者的病历资料进行回顾性分析，根据营养支持治疗方式分为早期肠内营养（EEN）组和阶段性肠外营养（TPN组），比较2组患者营养支持治疗第2周末的血红蛋白、空腹血糖等生化指标水平，第1、7天APACHEII评分和C反应蛋白（CRP）水平，以及胃肠道功能恢复时间、并发症发生率、住院时间、住院费用和病死率。结果治疗第2周末EEN组和TPN组患者血红蛋白、空腹血糖水平差异有统计学意义[（110±5）g／L比（102±18）g/L，（6．0±1．8）mmol／L比（9．2±3．6）mmol／L，均P〈0．05]；血钙、淋巴细胞计数、血Cr、胆固醇及血淀粉酶水平比较，差异均无统计学意义；治疗第7天时EEN组和TPN组CRP及APACHE-Ⅱ评分差异有统计学意义[（75±30）mg／L比（1204-33）mg／L，（7．8±1．7）分比（9．5±2．9）分，均P〈0．05]。早期组胃肠道功能恢复较早，且并发症、感染率、住院时间和费用低于阶段性组（P〈0．05），2组病死率差异无统计学意义。结论在SAP的治疗中，早期肠内营养支持治疗能缩短病程，减少并发症，改善患者预后。

Objective To explore therapeutic efficacy of early enteral nutrition （EEN） for severe acute pancreatitis（SAP）. Methods Fifty-eight patients with SAP were divided into the early group（30 cases） and stage group （28 eases）. Both groups had early enteral nutrition or initial parenteral nutrition support treatment respectively. The hemoglobin level,fasting blood glucose level and other indicators,the score of APACHE-Ⅱ and the level of serum CRP in different time, the change of intestines and stomach function, the incidence-of complication, the infection rate, the length of stay in hospital, inpatient expenditure and death rate were compared between the two groups. Results There were significant differences in hemoglobin level and fasting blood glucose level [ （110 ± 5 ）g/L vs （ 102±18 ） g/L, （ 6. 0 ± 1.8 ） mmol/L vs （ 9. 2 ± 3. 6 ） mmol/L, P 〈 0. 05 ], but no differences of serum calcium, lymphocyte count,serum creatinine, serum cholesterol and amylase level were observed. Patients treated with EEN had an early recovery of intestines and stomach function. There were significant differences in APACHE- Ⅱ score, serum CRP, complications, infection rate and hospitalized days. Inpatient expenditure was lower than that with stage nutrition support （ P 〈 0.05 ）. The rate of death had no differences between two groups. Conclusion Patients with SAP treated with EEN can decrease the length of stay in hospital with optimal therapy outcomes.