经空肠营养管给予免疫型肠内营养治疗重症急性胰腺炎的临床研究

Clinical research for the treatment of given immune enteral nutrition by the jejunum nutrition tube on the patients with severe acute pancreatitis

目的探讨经空肠营养管给予免疫型肠内营养支持治疗重症急性胰腺炎营养指标、免疫指标和炎性反应指标的变化。方法选择2013年1月—2015年12月邯郸市中心医院东区急诊外一科收治重症急性胰腺炎患者72例,随机数字表法分为研究组和对照组各36例。2组患者均给予急性胰腺炎规范化治疗,研究组经空肠营养管给予免疫型肠内营养支持,对照组给予肠外营养支持。比较治疗后2组患者营养指标(Alb、PAB)、体液免疫指标(血清IgA、IgG、IgM)、细胞免疫指标(TLC、CD3^+、CD4^+)和炎性反应指标(CRP、TNF-α、IL-6)的变化情况。结果 2组患者给予不同营养方式治疗后,各项指标均有明显改善,研究组治疗第7天、14天时Alib、PAB水平显著高于对照组(t_(7d)=1.717、2.957;t_(14d)=2.411、2.182,P<0.05;);研究组治疗第14天时IgA、IgG、IgM、TLC、CD3^+、CD4^+改善明显优于对照组(t=2.031、2.106、2.198、2.050、2.182、1.850,P<0.05),同时CRP、TNF-α、IL-6水平下降优于对照组(t=2.437、1.705、2.697,P<0.05)。结论经空肠营养管给予免疫型肠内营养支持治疗重症急性胰腺炎能更加有效地改善患者营养状况及免疫功能,降低患者急性反应期炎性反应,从而改善预后、提高临床疗效。

Objective To investigate the effect of enteral nutrition support in the treatment of severe acute pancreati -tis with nutritional index , immune index and inflammatory response index .Methods We collected 72 patients with severe a-cute pancreatitis from January 2013 to December 2015 .They were randomly divided into research group and control group , each group had 36 cases.All patients were treated with conventional treatment , research group were received immune enteral nutrition therapy by jejunum nutrition tube , control group were received parenteral nutrition support .Compare two groups after treatment, patients’ nutrition indicators （Alb, PAB）, humoral immunity （IgA, IgG, IgM）, cellular immunity （TLC, CD3 ＋, CD4 ＋） and inflammatory indicators （CRP, TNF-α, IL-6） changes.Results Two groups of patients given different nutrition after treatment , the indicators were obviously improved .At 7 days and 14 days, the ALB and PAB levels of the re-search group were significantly higher than that of the control group （ t 7 =1.717, t 7 =2.957;t 14 =2.411, t 14 =2.182, P 〈0.05）;Treatment for 14 days, the IgA, IgG, IgM, TLC, CD3 ＋, CD4 ＋of the research group were improved significantly better than the control group （ t =2.031, t =2.106, t =2.198, t =2.050, t =2.182, t =1.850, P 〈0.05）.At the same time, the CRP, TNF-α, IL-6 of the research group declined significantly than the control group （ t =2.437, t =1.705, t =2.697, P 〈0.05）.Conclusion The jejunum nutrition tube given immune enteral nutrition in treatment of severe acute pan -creatitis can effectively improve the nutritional status and immune function of patients , reduce the inflammatory reaction in pa-tients with acute reaction period , so as to improve the prognosis and improve the clinical efficacy .