重症急性胰腺炎早期肠内营养治疗36例应用分析

Clinical study of early enteral nutrition in patients with severe acute pancreatitis:a report of 36 cases

目的探讨早期肠内营养对重症急性胰腺炎患者血清炎症指标和临床转归的影响。方法72例重症急性胰腺炎患者，在入院24～48小时后随机分为早期肠内营养组（EEN组36例）和传统方法治疗组（对照组36例），行营养支持在内的综合治疗。观察两组患者症状、体征、白细胞（WBC）和血淀粉酶恢复正常的时间，同时比较两组患者间血清白蛋白、血清前白蛋白、住院时间、住院费用、急性生理与慢性健康状况评分（APACHEⅡ评分）、CT评分和胰腺及胰周感染发生率。结果EEN组患者经早期肠内营养治疗后临床症状、体征和血清生化指标恢复正常的时间较对照组明显缩短（P〈0．05）；EEN组患者在治疗后血清白蛋白、前白蛋白、淀粉酶、白细胞等较对照组明显好转（P〈0．05）；EEN组患者的住院时间较对照组也明显缩短，住院费用较对照组降低（P〈0．05）；EEN组患者经治疗14天后APACHEII和CT评分显著降低（P〈0．05），且胰腺及胰周感染发生率明显降低（P〈0．05）。结论早期肠内营养的合理应用有助于改善SAP患者的营养状况，具有良好的安全性和可行性。

Objective To evaluate the influence of early enteral nutrition in patients with severe acute pancreatitis（SAP）. Methods A total of 72 patients with severe acute pancreatitis were divided randomly into two groups. One group treated with early enteral nutrition in the intensive care unit（ ICU）, the other treated with traditional management. Complications of enteral nutrition were observed. APACHE II score, Balthazar CT score, serum levels of albumin, prealbumin and amylase, white blood cell count, duration of hospital stay, and cost of hospitalization were compared. Results On the 14th day, APACHE II scoreand Bahhazar CT score were significantly lowerafter early enteral nutrition. Duration of hospital stay and the cost of hospitalization was also lower after early enteral nutrition. Serum level of albumin was higher on the 14th day. Serum level of prealbumin was higher on 14th day. White blood cell count and amylase was lower on the 7th and 14th day （ P 〈 0.05 ） Conclusion Early enteral nutrition application in patients with SAP is safe and effective, which has contributed to improve the nutritional status of SAP patients.