微生态肠内营养支持治疗重症急性胰腺炎的疗效

Enteral Microecopharmaceutics Nutrition for Severe Acute Pancreatitis

目的探讨微生态肠内营养支持治疗重症急性胰腺炎(SAP)的临床疗效。方法将66例SAP患者按入院的先后顺序分为观察组和对照组,每组33例。2组均给予常规治疗,同时给予肠内营养混悬液治疗。在此基础上,观察组加用复合乳酸菌胶囊治疗。观察2组治疗前,治疗7、14d后生化指标[血浆降钙素原(PCT),血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、脂肪酶(LIP)、白蛋白(ALB)、前白蛋白(PA),白细胞(WBC)计数]的变化和APACHEⅡ评分、Balthazar CT评分及肠内营养耐受性、住院时间、病死率。结果观察组肠内营养耐受性良好所占比例与对照组比较差异有统计学意义(P<0.05),观察组住院时间较对照组短(P<0.05)。与治疗前比较,2组治疗7、14d后血浆PCT,血清TNF-α、IL-6、LIP水平及WBC计数值,APACHEⅡ评分、Balthazar CT评分均明显下降,血清ALB、PA水平均明显升高(均P<0.05);与治疗7d后比较,2组治疗14d后血浆PCT,血清TNF-α、IL-6、LIP水平及WBC计数值,APACHEⅡ评分、Balthazar CT评分均下降,血清ALB、PA水平均升高(均P<0.05);与对照组比较,观察组治疗7、14d后血浆PCT,血清TNF-α、IL-6、LIP水平及WBC计数值均下降更明显,血清ALB、PA水平均升高更明显(均P<0.05)。结论微生态肠内营养支持治疗SAP能够有效改善肠道菌群,减轻炎症反应,提高患者的免疫力,是一种安全、有效的营养支持方式。

Objective To investigate the clinical effect of enteral microecopharmaceutics nutrition on severe acute pancreatitis（SAP）.Methods According to the order of admission,66 patients with SAP were divided into observation group and control group,with 33 patients in each group.Both groups were given conventional treatment and enteral nutritional supplementation.The observation group was additionally treated with lactobacillus complex capsules.Plasma concentrations of procalcitonin（PCT）,serum levels of tumor necrosis factor alpha（TNF-α）,interleukin-6（IL-6）,lipase（LIP）,albumin（ALB）and prealbumin（PA）,and white blood cell（WBC）count were measured before and after treatment for 7and 14 days.In addition,APACHE scores,Balthazar CT scores,tolerance of enteral nutrition,hospital stay,and mortality rate were observed in both groups.Results There was a significant difference in the proportion of patients well tolerated enteral nutrition between the two groups（P〈0.05）.The length of hospital stay in observation group was shorter than that in control group（P〈0.05）.After treatment for 7and 14 days,plasma PCT concentrations,serum TNF-α,IL-6and LIP levels,WBC count,APACHE scores and Balthazar CT scores decreased,but serum ALB and PA levels increased in both groups（P〈0.05）.Furthermore,changes in these indicators measured after treatment for 14 days were more obvious than those measured after treatment for 7days（P〈0.05）.Compared with control group,plasma PCT concentrations,serum TNF-α,IL-6and LIP levels and WBC count decreased,but serum ALB and PA levels increased in observation group（P〈0.05）.Conclusion As a safe and effective nutritional support,enteral microecopharmaceutics nutrition can improve intestinal flora,reduce inflammation and enhance immunity in patients with SAP.