肠内外营养支持联合微生态制剂治疗对重症急性胰腺炎患者临床预后的影响

THE EFFECT OF THE METHOD OF ENTERAL AND PARENTERAL NUTRITION SUPPORT COMBINED WITH MICROECOLOGICAL PREPARATIONS ON THE PROGNOSIS OF THE PATIENTS WITH SEVERE ACUTE ANCREATITIS

目的探讨肠内外营养支持联合微生态制剂治疗重症急性胰腺炎(SAP)的临床疗效。方法将72例SAP患者随机分为观察组(36例)和对照组(36例)。二组均给予急性胰腺炎规范化治疗,包括监测生命体征、禁食水、胃肠减压、补充液体、维持水电解质和酸碱平衡、抗感染、镇痛、抑酸治疗、抑制胰酶活性等。对照组给予完全胃肠外营养支持(TPN)治疗,观察组给予以胃肠外营养联合肠内营养治疗,同时使用微生态制剂。比较二组患者治疗效果及血、尿淀粉酶恢复正常时间;入院时及营养支持治疗后第三天、七天、十四天的APACHE-Ⅱ评分以及血清白蛋白和血清前白蛋白变化情况。结果观察组疗效优于对照组(P<0.05),观察组血尿淀粉酶恢复正常时间均短于对照组(P<0.01)。二组治疗第三天时APACHE-Ⅱ评分均下降,差异无统计学意义(P>0.05)。二组治疗第七天、十四天时APACHE-Ⅱ评分以观察组下降更明显(P<0.05)。二组患者治疗后血清白蛋白和血清前白蛋白水平与治疗前比较均明显改善,治疗前后比较,差异均有统计学意义(P<0.01);治疗后观察组血清白蛋白和血清前白蛋白水平与对照组比较,差异有统计学意义(P<0.05)。结论肠内、外营养支持联合微生态制剂治疗重症急性胰腺炎能够提高临床疗效,改善患者营养状况,值得推广应用。

Objective To investigate the clinical efficacy of method of enteral and parenteral nutrition support combined with microecological preparations in the treatment of patients with severe acute pan-creatitis. Methods A total of 72 patients with severe acute pancreatitis were randomly divided into treatment group and control group, 36 cases in each group. All patients were treated with conventional treatment, monitoring vital signs, fasting water, gastrointestinal decompression, venous transfusion, balance of water, electrolyte and acid-base, antiinfection, analgesia, acid suppression therapy, sup-pression of trypsin activity were included. Control group were treated with total parenteral nutrition. Treatment group were received parenteral nutrition combined with enteral nutrition therapy and micro-ecological preparations. Therapeutic effect and blood and urine amylase returned to normal time were compared in two groups. The acute physiology and chronic health evaluation Ⅱ score（ APACHE Ⅱ ） were calculated before and after 3 days,7 days and 14 days respectively. Meanwhile, serum albumin and serum prealbumin after treatment were compared. Results The curative effect of treatment group was superior to control group（P〈0.05）. Compared with control group, blood and urine amylase re-turned to normal time of patients in treatment group shortened （P〈0.01）. The APACHE- Ⅱ score after treatment in two groups at 3 days decreased, but the differences were no statistically significant （P〉0.05）. The APACHE-Ⅱ score after treatment at 7 days and 14 days decreased in two groups, but more obvious decreased was in treatment group （P〈0.05）. After treatment, serum albumin and prealbumin levels of the two groups were significantly improved than those before treatment, the differences were statistically significant （P〈0.01）. After treatment serum albumin and serum preal-bumin levels were compared between treatment group and control group, the differences were statisti-cally significant （P〈0.05）. Conclusion The method of enteral and parenteral nutrition support com-bined with microecological preparations can improve the clinical efficacy and the patients nutritional status of severe acute pancreatitis. It is worthy of widely application.