早期肠内营养对老年重症急性胰腺炎患者炎症反应和肠黏膜屏障功能的影响

Influence of early enteral nutrition on the inflammatory reaction and function of intestinal mucosa barrier in elderly patients with severe acute pancreatitis

目的探讨早期肠内营养对老年重症急性胰腺炎(SAP)患者炎症反应和肠黏膜屏障功能的影响。方法选取74例老年SAP患者,分为早期组38例和常规组36例,早期组患者入院后2~4 d开始行肠内营养;常规组患者待肠道排气后行肠内营养。比较两组患者的临床疗效、治疗后炎症因子白细胞介素-1(IL-1)、IL-6、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)和尿乳果糖/甘露醇(L/M)水平的变化。结果早期组入院后第14天急性生理和慢性健康状况评分Ⅱ(APACHEⅡ)评分、住院时间及住院费用均明显低于常规组,差异有统计学意义(t分别=2.52、4.52、7.22,P均<0.05)。但早期组入院后第7天APACHEⅡ评分、感染率、多器官功能障碍综合征(MODS)发生率、病死率与常规组比较,差异均无统计学意义(t=0.68,χ~2分别=0.70、0.64、0.01,P均>0.05)。早期组和常规组患者血清IL-1、IL-6、TNF-α、CRP及尿L/M水平治疗后均呈下降趋势(F分别=105.27、88.90、61.82、55.30、129.25;78.97、47.53、26.60、36.14、105.26,P均<0.05)。早期组入院后第5、7、14天的血清IL-1、IL-6、TNF-α及CRP水平均低于常规组,差异有统计学意义(t分别=3.74、3.33、2.65、2.15;2.38、3.45、3.29、2.08;2.62、6.41、4.88、3.28,P均<0.05)。且早期组入院后第7、14天尿L/M水平亦明显低于常规组(t分别=4.38、6.16,P均<0.05)。结论早期肠内营养可以提高老年SAP患者的临床疗效、减轻炎症反应和保护肠黏膜屏障功能。

Objective To explore the influence of early enteral nutrition on the inflammatory reaction and function of intestinal mucosa barrier in elderly patients with severe acute pancreatitis （SAP）. Methods Seventy-four elderly patients with SAP were divided into early group （n=38）and common group （n=36）. The early group was received enteral nutrition at 2 to 4 days after admission,and the common group was received enteral nutrition after exsufflation. The clinical efficacy,levels of IL- 1, IL-6,TNF-α, C-reaction protein （CRP）and urinary lactulose/mannitol （L/M）between two groups were compared. Results In the early group,the score of APACHE Ⅱ at 14^th day after admission, hospital stay and expense were significantly lower than those in the common group（t=2.52,4.52,7.22,P〈 0.05）. But there was no difference in the score of APACHE Ⅱ at 7^th day after admission,infection rate,incidence rate of multiple organ dysfunction syndrome and mortality between the two groups （t=0.68,x^2=0.70,0.64,0.01,P〉 0.05）. The levels of serum IL-1,IL-6,TNF-α,CRP and urinary L/M gradually decreased after admission in the early group and common group （F=105.27,88.90,61.82,55.30,129.25;78.97,47.53,26.60,36.14,105.26,P〈0.05）.In the early group,the levels of IL-1,IL-6,TNF-α and CRP at 5^th,7^th,14^th days after admission and the levels of urinary L/M at 7^th,14^th days after admission were significantly lower than those in the common group （t = 3.74,3.33,2.65,2.15;2.38,3.45,3.29,2.08,4.38;2.62,6.41,4.88,3.28,6.16,P 〈0.05）. Conclusion Early enteral nutrition can improve the clinical efficacy,reduce inflammatory response and protect the function of intestinal mucosa barrier of elderly patients with severe acute pancreatitis.