早期肠内生态免疫营养在重症急性胰腺炎中的应用

Application of early enteral ecoimmunonutrition in severe acute pancreatitis

目的:比较早期肠内生态免疫营养(EIN)与常规早期肠内营养(EN)支持对重症急性胰腺炎(SAP)患者的临床效果。方法:将64例先后入院的SAP患者随机分为观察组和对照组,每组32例,两组早期给予EN;观察组在此基础上应用谷氨酰胺颗粒及三联活菌制剂。观察两组的病例脱落情况,以及EN支持前与EN支持9 d后的营养状况、炎性指标及全血细菌DNA阳性率、血浆D-乳酸、血浆二胺氧化酶(DAO)、血浆内毒素及尿中乳果糖/甘露醇(L/M)比值。结果:对照组有4例患者脱落未能按照营养支持要求进行。与EN前比较,EN支持9 d后,两组血清白蛋白、前白蛋白、转铁蛋白变化绝对值均升高;白细胞介素2、白细胞介素6、肿瘤坏死因子α均降低;全血细菌DNA阳性率、血浆D-乳酸、血浆DAO、血浆内毒素和尿L/M比值均降低,但观察组以上各项指标的变化幅度均明显大于对照组(均P<0.05)。结论:早期合理的EIN有利于改善SAP患者营养状况、抑制炎症反应、维护肠黏膜屏障功能,值得临床应用。

Objective： To compare the clinical efficacy of early enteral ecoimmunonutrition （EIN） and conventional early enteral nutrition （EN） in patients with severe acute pancreatitis （SAP）. Methods： Sixty-four consecutive SAP patients were randomly designated to observational group and control group, with 32 cases in each group. Patients in both groups received early EN support, while those in observational group were additionally supplemented with glutamine granules and triple vital bacteria composition. The case dropout, and nutrition status, inflammatory indexes and positive rate of bacterial DNA extraction in whole blood and plasma levels of diamine oxidase （DAO）, D-lactate acidosis, endotoxin as well as the lactulose to mannitol ratio （L/M） in urine before and 9 d after of EN support were observed in the two groups.Results： There were 4 dropout cases in control group who were not able to follow the requirements of the nutritional support. In both groups on 9 d after EN support compared with the data before EN support, the levels of serum albumin, prealbumin and transferrin were increased; the levels of interleukin-2, interleukin-6 and tumor necrosis factor-or were decreased; the positive rate of bacterial DNA extraction and the plasma levels of DAO, D-lactate acidosis, endotoxin and L/M ratio were decreased, however, the changing amplitudes in all these parameters in observational group were greater than those in control group （all P〈0.05）. Conclusion： Rational early EIN is beneficial in improving the nutrition status, inhibiting inflammatory responses and maintaining intestinal barrier function in SAP patients, so it is recommended to be used.