摘要
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.
出处
《全科医学临床与教育》
2017年第2期149-152,共4页
Clinical Education of General Practice
关键词
重症急性胰腺炎
老年
肠内营养
炎症
肠黏膜屏障
severe acute pancreatitis
elderly
enteral nutrition
inflammatory
intestinal mucosa barrier