鼻胃管肠内营养对中—重度急性胰腺炎的临床疗效研究

The effects of nasogastric enteral nutrition on moderate-severe acute pancreatitis

目的 :探讨鼻胃管肠内营养(NGEN)在中-重度急性胰腺炎(M-SAP)治疗中的临床疗效、安全性及耐受性。方法 :收集2013年11月至2014年8月我院消化科住院病人中符合诊断标准的M-SAP病人60例,其中30例使用鼻胃管予以肠内营养(EN),30例使用鼻空肠管进行EN,比较两组病人在肠道通透性(内毒素、D-乳酸)、炎症反应指标(CRP、IL-6、TNFα)、营养情况、管饲副作用(反流误吸、腹痛加重、腹泻)的发生率及病人病情评估(APACHE II评分、MCTSI评分)、预后(感染并发症发生率、病死率、住院时间、住院费用)等方面差异是否存在统计学意义。结果 :在肠道通透性、炎症反应指标、营养状况评价、整体病情评估、预后等方面,两组差异无统计学意义(P>0.05),但在反流误吸上,鼻胃管肠内营养组(NG组)发生率为20%,鼻空肠管肠内营养组(NJ组)为3.3%,差异有统计学意义(P<0.05)。结论:M-SAP患者行NGEN治疗与鼻空肠管肠内营养(NJEN)在SAP病情变化、营养情况、肠道通透性、预后等方面作用相当,NGEN方法简便,值得临床重视。NGEN发生反流误吸风险较NJEN大,其在M-SAP应用的安全性方面,尚需更多大样本随机对照实验加以研究。

Objective： To explore the clinical efficacy, safety and tolerability of nasogastric enteral nutrition （NGEN） on moderate-severe acute pancreatitis （M-SAP）. Methods： Sixty patients diagnosed as M-SAP and admitted admitted to Department of Gastroenterology, Affiliated Hospital of Southwest Medical University from November 2013 to August 2014 were randomized to receive enteral nutrition （EN） via a nasogasteic tube （n = 30） or a nasojejunal tube （n = 30）. The intestinal permeability （endotoxin, D - lactic acid）, inflammation index （CRP, IL-6, TNF- α ）, nutrition status, nutrition-related adverse effects （reflux aspiration, diarrhea and abdominal pain worse situation）, condition assessment （APACHE II and MCTSI）, and prognosis （infection complications, mortality, length of hospital stay, hospital expenses） were collected and compared. Results： There was no statistically significant difference in the two groups as for intestinal permeability, inflammation index, evaluation of nutritional status, overall condition assessment, and prognosis （P 〉 0,05）. On the reflux aspiration, the rate of nasogastric tube enteral nutrition group （NG group） was 20%, nasojejunal enteral nutrition group （NJ group） was 3.3%, the difference was statistically significant （P 〈 0.05）. Conclusion： Either NGEN or NJEN has the similar effects on disease evolution, nutrition condition, intestinal permeability and prognosis of M-SAP. NGEN is simple and worthy of clinical attention. The nasogastric may more easily lead to reflux aspiration than the nasojejunal route. It requires more randomized controlled study to investigate its safety on SAR.