经鼻肠营养管超早期肠内营养支持治疗重症急性胰腺炎的临床对照研究

Clinical Controlled Study on Super Early Enteral Nutrition Support Treatment in Severe Acute Pancreatitis

目的：探讨DSA引导下经鼻肠营养管超早期肠内营养在重症急性胰腺炎（ severe acute pancreatitis ， SAP）治疗中的有效性和安全性。方法回顾分析我院2008年6月-2011年3月120例符合SAP诊断标准的临床资料，其中60例入院24 h之内给予DSA引导下经鼻肠营养管植入（超早期肠内营养组），60例禁食期间未行任何方式的肠内营养支持治疗（完全胃肠外营养组）。比较2组患者住院时间、住院费用、病死率、入院前后的APACHE Ⅱ评分、Ranson评分，治疗14 d后血、尿淀粉酶、血清白蛋白及血清前白蛋白等。结果超早期肠内营养组总住院时间（41．5±21．1） d，明显短于完全胃肠外营养组（58．9±26．7）d（t＝-3．369，P＝0．001）；住院费用（67416．9±22659．5）元，明显少于完全胃肠外营养组（383592．5±92493.5）元（t＝-25．718，P＝0．000）；腹腔感染率6．7％（4/60），显著低于完全胃肠外营养组25．0％（15/60）（χ2＝7．566， P＝0.006）；院内感染率26．7％（16/60），显著低于全胃肠外营养组56．7％（34/60）（χ2＝11．109，P＝0．001）。2组患者治疗前后的血淀粉酶、尿淀粉酶、C-反应蛋白、血清前白蛋白、APACHE Ⅱ评分、Ranson评分均有显著性差异（ P＜0．05）；2组治疗后血、尿淀粉酶、血清前白蛋白、血清白蛋白和C-反应蛋白降幅有统计学差异（ t＝16．968，P＝0．000；t＝35．348，P＝0．000；t＝20．072，P＝0.000；t＝-22．359，P＝0．000；t＝-2．234，P＝0．027），但2组治疗后APACHE Ⅱ评分、Ranson评分无统计学差异（ P＞0．05）。结论与完全胃肠外营养组相比，超早期肠内营养在SAP治疗中安全、有效，无严重并发症，同时具有营养丰富、费用低等优点。

Objective To explore the effectiveness and the safety of super early enteral nutrition （SEEN） in the treatment of severe acute pancreatitis （SAP）. Methods Clinical data of 120 patients diagnosed as SAP in this hospital during June 2008 to March 2011 were retrospectively reviewed .Among the 120 patients, nose intestinal feeding tube placement under the guidance of DSA within 24 hours after admission was carried out in 60 patients （super early enteral nutrition group, SEEN）, while the other 60 patients did not accept the treatment of intestinal feeding tube placement （ total parenteral nutrition group , TPN） .The length of stay ,incidence of serious complications, mortality, curative effects, APACHEⅡ scores, Ranson grades,amylase levels 14 days after treatment, and serum albumin and prealbumin changes were compared between the two groups . Results The SEEN group showed shorter length of hospital stay[（41.5 ±21.1） d vs.（58.9 ±26.7） d, t=-3.369, P=0.001] and lower hospitalization expenses [（67 416.9 ± 22 659.5） yuan vs.（383 592.5 ±92 493.5） yuan, t=-25.718, P=0.000].The SEEN group had an abdominal infection rate of 6.7%（4/60） and a nosocomial infection rate of 26.7%（16/60）, which were less than the TPN group [25.0% （15/60）, χ2 =7.566, P=0.006;56.7%（34/60）,χ2 =11.109, P=0.001].There were significant differences in serum amylase , urine amylase, C-reactive protein, serum prealbumin, APACHE Ⅱ scores, and Ranson scores before and after the treatment in both groups （P〈0.05）.After treatment, there were significant differences between the two groups in levels of blood amylase , urine amylase,prealbumin, serum albumin, and C-reactive protein （t =16.968,P=0.000;t =35.348,P =0.000;t =20.072,P =0.000;t=-22.359,P=0.000;t=-2.234,P=0.027）.There were no obvious statistical significances in APACHE Ⅱ scores and Ranson scores between the two groups after treatment （P〉0.05）. Conclusion Super early enteral nutrition is a safe and effective method for SAP, bearing advantages of no serious complications , cost-effectiveness, and rich nutrition.