急性重症胰腺炎患者早期肠内外营养支持的效果评价

Effects of enteral nutrition and total parenteral nutrition for severe acute pancreatitis patients in early stage

目的:评价急性重症胰腺炎患者早期肠内外营养支持有无差异。方法:将我院近两年收治的急性重症胰腺炎患者39例分为早期肠内营养组(EN组13例)和早期肠外营养组(TPN组14例),对照组(12例)。在常规治疗基础上,EN组早期留置液囊空肠营养管行空肠营养,TPN组早期行静脉高糖氨基酸治疗,对照组早期未行肠内外营养支持。分别在治疗1、2、3周后比较三组总胆红素、WBC、APACHEⅡ评分、Ranson评分和C-反应蛋白(CRP)、血淀粉酶、尿淀粉酶恢复时间、白蛋白变化情况,于出院时比较感染并发症率、病死率、平均住院时间等。结果:三组患者APACHEⅡ评分和Ranson评分差异无统计学差异;第2周时,EN组及TPN组白细胞和CRP水平显著低于对照组,第2、3周时,EN组和TPN组血清白蛋白水平明显高于对照组(P<0.05);EN组及TPN组感染率、感染并发症、平均住院时间明显低于对照组(P<0.05),EN组更优,但TPN组肠胀气及消化道出血发生率低于EN组及对照组,尤其是较高龄人群。结论:早期营养支持可以显著改善急性重症胰腺炎患者营养状况,缩短病程、减低感染率、病死率、并发症发生率。但针对不同年龄人群,可选择不同营养支持方法。

Objective： To compare the effect of enteral nutrition and total parenteral nutrition in severe acute pancreatitis patients in early stage. Method： Thirty-nine severe acute pancreatitis patients admitted in our hospital in the past two years were divided into 3 groups, early enteral nutrition group （EN,n= 13）,total parenteral nutrition group （TPN,n=14）,and control group （n= 12）. Based on comprehensive treatment, the patients in group EN were given enteral nutrition by endoscopic nasojejunal feeding,while those in group TPN were given venous sugar amino acid treatment in the early stage, the patients in control group had no nutrition support. The WBC, APACHEII score,Ranson score,C-reactive protein （CRP）, serum amylase, urinary amylase and serum albumin 1 week,2 weeks and 3 weeks after treatment were observed. The infection complication incidence,mortality rate and hospital stays were paid attention. Result：Differences of APACHE 1I score and Ranson score in the three groups of patients had no statistical difference. Two weeks after treatment, the levels of WBC and CRP in EN and TPN groups were significantly lower than the control group. Two weeks and three weeks after treatment, the level of serum albumin in EN and TPN groups was obviously higher than control group （P〈0.05）. The infection rate,complication incidence,average hospital stays in EN and TPN groups were significantly lower than control group （P〈 0.05）. However, the abdominal distension and gastrointestinal hemorrhage rate of SAP patients, especially the aged in TPN group were significant lower than other groups. Conclusion： Early nutrition support can improve the nutritional status of SAP patients, shorten the hospital stays, reduce the infection rate, complication incidence and mortality rate. However, different nutrition support methods differ in different patients.