早期肠内营养辅助治疗重症胰腺炎的临床疗效分析

Analysis of the Clinical Effect of Early Enteral Nutrition on the Severe Acute Pancreatitis

目的:探讨早期肠内营养辅助治疗重症胰腺炎的临床效果。方法:选择2009年4月～2012年2月我院收治的重症胰腺炎患者共46例,随机分为实验组和对照组各23例,实验组在综合治疗的基础采用早期肠内营养治疗(EN),而对照组在综合治疗的基础上采用全胃肠外营养治疗(TPN),比较两组患者的血清总蛋白、白蛋白、尿素氮水平及血淋巴细胞百分比变化、血淀粉酶和尿淀粉酶恢复正常时间、住院时间及病死率,并比较两组治疗前及治疗后24、48及72小时的APACHE II评分。结果:治疗后,实验组患者的血清总蛋白、白蛋白、尿素氮水平及血淋巴细胞百分比变化均较对照组明显增高,差异有统计学意义(P<0.05),而血淀粉酶、尿淀粉酶恢复时间、病死率及住院时间分别均明显较对照组降低或缩短,差异有统计学意义(P<0.05)。治疗24、48及72小时后,实验组APACHE II评分均较治疗前显著减低(P<0.05),而对照组治疗24、48h后APACHE II评分与治疗前比较差异无统计学意义(P>0.05),治疗72h后APACHE II评分较治疗前显著减低(P<0.05)。结论:采用早期肠内营养辅助治疗重症胰腺炎患者能有效保护肠黏膜屏障功能,改善患者的营养状况,增强患者的免疫力,并改善患者的预后。

Objective： To investigate the clinical effect of early enteml nutrition in the treatment of severe acute pancreatitis. Methods： 46 cases of severe acute pancreatitis admitted in our hospital from April 2009 to February 2012 were selected and randomly divided into the, experimental group and control group （23 cases in each group）, The experimental group was early enteral nutrition therapy （EN）, while the control group treated by total parenteral nutrition （TPN） based on the comprehensive treatment. The total protein, serum albu- min, blood urea nitrogen and percentage of blood lymphocyte change, blood and urine amylase, recovery time and mortality occurred in normal time were compared between two groups. The APACHE II score were compared between before treatment and 24, 48 and 72 hours after treatment. Results： The total serum protein, albumin, urea nitrogen and percentage of blood lymphocyte change of experimen- tal group were significantly higher than those of the control group （P〈0.05）, while the recovery time of serum amylase, urine amylase, mortality rate and hospital stay were significantly shorter or lower than those of the control group （P〈0.05）. The APACHE II scores of experimenta! group 24, 48 and 72h after treatment were significantly lower than that before treatment （P〈0.05）, while no significant dif- ference of APACHE II scores of the control group was found between 24, 48h after treatment and before treatment （P〉0.05）, which was significantly lower 72h after treatment （P〈0.05）. Conclusion： Early enteml nutrition support could effectively protect the intestinal mucosal barrier function improve the nutritional status, enhance the immunity, reduce the mortality rate, and improve the prognosis of patients with severe acute panereatitis.