早期肠内营养和肠外营养在治疗重症急性胰腺炎中的疗效对比研究

Comparative studies on therapeutic effects of early enteral and parenteral nutrition on severe acute pancreatitis

目的比较早期肠内营养和肠外营养对重症急性胰腺炎病情发展经过和预后的不同影响,探讨早期肠内营养在重症急性胰腺炎中的治疗作用。方法收集2009年1月至2011年9月间在浙江省绍兴市第二医院住院治疗的重症急性胰腺炎患者65例,根据患者个人意愿分为肠内营养组(33例)和肠外营养组(32例)。肠内营养组为在内镜引导和证实下将空肠营养管越过十二指肠乳头送达空肠并妥善固定,肠外营养通过深静脉导管静脉滴注。两组均在患者腹痛后48h内即开始给予营养支持,并比较多器官功能障碍发生率、感染发生率、入住重症监护病房(ICU)率和最终病死率的差异。结果肠内营养组中多器官功能障碍发生率、感染发生率、入住ICU率和最终病死率分别为:36.36%、24.24%、39.39%和21.21%;而肠外营养组分别为:40.63%、50.00%、46.88%和25.00%。两组患者中,多器官功能障碍发生率、入住ICU率和最终病死率等比较,差异均无统计学意义(P均>0.05),但肠内营养组患者的感染发生率明显低于肠外营养组,差异具有统计学意义(P<0.05)。结论与肠外营养相比,早期肠内营养不会增加重症急性胰腺炎患者发生多器官功能障碍、入住ICU和死亡的风险,但可降低感染发生率。

Objective To compare the different effects of early enteral nutrition （EN） and parenteral nutrition （PN） on development and prognosis in patients with severe acute pancreatitis （SAP）, and to study the therapeutic effect of EN on SAP. Methods A total of 65 SAP patients who admitted in Shaoxing second hospital of Zhejiang province from January 2009 to December 2011 were collected and divided into EN （33 cases） and PN （32 cases） groups according to their own chooses. Patients in EN group were treated via jejunum nutrition tube and confirmed by endoscope, and PN via deep venous catheter at 48 h after the beginning of abdominal pain. The incidences of multiple organ dysfunction syndrome （MODS）, infection, admission to intensive care unit （ICU） and death were compared. Results The incidences of MODS, infection, admission to ICU and death in EN group were 36.36%, 24.24%, 39.39% and 21.21%, whereas in PN group were 40.63%, 50.00%, 46.88% and 25.00%, respectively. The incidence of infection showed significant difference between the two groups （P〈 0.05）. Conclusion Compared with PN, EN will not increase the risks of MODS, admission to ICU and death, and meanwhile reduce the infection in the patients with SAP.