早期肠内外营养支持在重症急性胰腺炎治疗中的作用观察

Clinical value of enteral nutrition via a nasojejunal feeding tube placed endoscopically and total parenteral nutrition in acute severe pancreatitis

目的：比较肠内外营养支持对重症急性胰腺炎（SAP）的临床疗效。方法回顾性分析行经胃镜放置鼻空肠营养管行肠内营养（NENE）的35例SAP患者资料，选择同期行完全胃肠外营养支持（TPN）患者35例作为对照，比较两组营养支持前后（营养支持4周）的营养指标、Ranson评分、APACHEⅡ评分、CT评分以及各种并发症、病死率的发生情况。结果经营养支持4周后，NENE组血红蛋白和血清白蛋白分别为（108±21）g／L和（38．7±9．5）g／L，均显著高于TPN组的（92±16）g／L、（30．1±8．3）g／L（t＝3.928、3．684，均P＜0．05）；空腹血糖水平为（5．1±1．2）mmol／L，显著低于TPN组的（7．3±1．4）mmol／L（t＝4．128，P＜0．05）。NENE组CRP、TNF-α、IL-1以及IL-6分别为（32．1±12．3） mg／L、（34．4±12．3） ng／L、（22．4±11．3） ng／L、（32.4±11．3）ng／L，均显著低于 TPN 组的（50．2±13．5） mg／L、（47．2±12．5） ng／L、（33．1±11．5） ng／L、（43．1±11．5）ng／L（t＝3．927、4．925、4．258、4．825，均P＜0．05）。 NENE组感染、多器官功能不全、高血糖症和病死率分别为17．14％、8．57％、5．71％、5．71％，均显著低于TPN组的28．57％、17．14％、14．29％、11.43％（χ^2＝4．167、4．529、5．082、4．926，均P＜0．05）。结论与TPN相比，NENE不仅能降低SAP患者的病死率，还可显著减少各种感染、多脏器功能衰竭等并发症的发生率，缩短患者的住院时间和降低住院费用，降低疾病的严重程度和患者的经济负担，其价值更优于TPN。

Objective To analyze clinical value of enteral nutrition via a nasojejunal feeding tube placed endoscopically and total parenteral nutrition in severe acute pancreatitis（SAP） .Methods 35 patients with SAP were received nasojejunal enteral nutrition endoscopically（NENE）,while other 35 patients were received total parenteral nutrition（TPN）.After nutrtion support for 4 weeks the nutrition index,Ranson score,APACHE score and CT score and complications and mortality rate of occurrence between the two groups were compared.Results After nutrition support of 4 weeks,the levels of hemoglobin and serum albumin of NENE group were （108 ±21） g/L,（38.7 ±9.5） g/L, which were significantly higher than those of TPN group（t=3.928,3.684,all P〈0.05）,while the fasting blood glucose of（5.1 ±1.2）mmol/L was significantly lower than that of TPN group（P〈0.05）,the level of CRP,TNF-α, IL-1 and IL-6 in patients of NENE group were （32.1 ±12.3）mg/L,（34.4 ±12.3）ng/L,（22.4 ±11.3）ng/L, （32.4 ±11.3）ng/L,which were significantly lower than those of TNP group（t=3.927,4.925,4.258,4.825,all P〈0.05）;the incidence of multiple organ dysfunction,hyperglycemia of NENE group were 17.14%,8.57%,5.71%, 5.71%,which were significantly lower than those of TPN group（χ^2 =4.167,4.529,5.082,4.926,all P〈0.05）. Conclusion Nasojejunal enteral nutrition endoscopically is safe in clinical application.Compared with TPN,NENE results in better control of the incidence of complication, and decreased the length of stay in hospital and the cost enteral nutrition were more beneficial than total parenteral nutrition.