内镜联合肠内营养治疗老年急性胆源性胰腺炎的疗效分析

Efficacy analysis on combination use of endoscopy and enterai nutrition in the treatment of acute biliarypancreatitis in elderly patients

目的探讨内镜联合肠内营养（EN）治疗老年急性胆源性胰腺炎（ABP）的疗效及对预后的影响。方法84例ABP患者按照治疗方式的不同分为联合治疗组（联合组）和常规治疗组（常规组），每组42例。常规组采用常规综合治疗，联合组在此基础上采用内镜下括约肌切开术（EST）取石、鼻胆管引流术（ENBD）以及肠内营养（EN）治疗。比较两组患者的临床症状、血清炎症因子及生化指标、并发症发生率及病死率。结果治疗前后两组患者血清C反应蛋白（CRP）、TNF-α、IL-2、血淀粉酶、血糖、谷草转氨酶（AST）均较治疗前显著下降（P值均〈0．05），且联合组治疗后血清CRP、TNF-α、IL-2、血淀粉酶、AST及白蛋白（ALB）下降较常规组更显著（P值均〈0．05）。联合组腹痛缓解时间、体温降至正常时间、住院天数分别为（4．6±1．3）、（3．7±1．3）、（13．5±2．7）d，较常规组的（6．1±1．3）、（5．5±2．1）、（18．1±3．8）d明显缩短（P值均〈0．05）。联合组治疗后APACHEⅡ评分为（7．1±1．8）分，较常规组的（9．2±2．6）分下降更显著（t=3．41，P〈0．05）。联合组急性肾功能衰竭、急性呼吸窘迫综合征、胰周感染及腹腔大出血的发生率分别为7．1％、4．8％、4．8％、4．8％，均显著低于常规组的23．8％、19．1％、21．4％、19．1％（P值均〈0．05）。联合组的病死率低于常规组（4．8％比16．7％），但差异无统计学意义。结论内镜联合EN治疗老年ABP患者安全有效，可明显减少并发症发生率。

Objective To investigate the effectiveness of endoscopy and enteral nutrition （EN） in the treatment of acute biliary pancreatitis （ABP） in elderly patients and its impact on prognosis. Methods Eighty-four elderly patients with ABP were randomly divided into two groups, including 42 cases of combination treatment group, 42 cases of routine treatment group. The routine treatment group was managed with normal comprehensive treatment, and in combination treatment group, patients were treated with additional endoscopic retrograde cholangiopancreatography （ ERCP）, endoscopic sphincterotomy （EST） and endoscopic naso-biliary （ENBD） drainage and EN. The clinical symptoms, serum inflammatory cytokines, complications and prognosis were compared. Results The CRP, TNF-α, IL-2, and serum amylase, glucose, AST after treatment were significantly lowered than those before treatment （P 〈0.05）. In addition, the levels of CRP, TNF-α, IL-2, and serum amylase, glucose, AST, ALB in combination treatment group were significantly lower than those in routine treatment group （P 〈 0.05）. The time to abdominal pain cessation, time to fever cessation, hospital stay in combination treatment group were （4.6±1.3）, （3.7± 1.3）, （13.5± 2.7） d, which were significantly lower than those in routine treatment group [ （ 6.1± 1.3 ）, （ 5.5± 2.1 ）, （ 18.1±3.8 ） d, P 〈 0.05 ]. The APACHE Ⅱ score of combination group after treatment was （7.1 ± 1.8） point, which wassignificantly lower than that in routine treatment group [ （ 9.2 ± 2.6 ） point, t = 3.41, P 〈 0.05 ） ]. The incidence rates of ARF, ARDS, peri-pancreatic infection and abdominal hemorrhage, in combination group were 7.1%, 4.8%, 4.8%, 4.8%, respectively, which were significantly lower than those in routine treatment group （23.8%, 19.1%, 21.4%, 19.1%, P〈0.05）. The mortality in combiration group was 4.8%, which was lower than 16.7% in routine treatment group with no statistical significant. Conclusions It is a safe and effective to treat elderly ABP patients with endoscopy combined with EN, which can significantly reduce complications and mortality.