EEN在重症急性胰腺炎治疗中的效果研究

Study on the effect of EEN in the treatment of severe acute pancreatitis

目的探讨早期肠内营养（early enteral nutrition，EEN）在重症急性胰腺炎治疗中的效果。方法对比性分析2010年1月-2015年12月惠州市中心人民医院65例重症急性胰腺炎患者的临床资料，根据其治疗方式分为常规治疗组（30例）和观察组（35例）。常规治疗组在患者机体内环境相对稳定状况下先开始实施肠外营养，在平均7d循环和呼吸等生命体征稳定状况下，开始给予肠内营养；观察组在入院后平均72h患者生命体征、水电解质和酸碱平衡相对稳定状况下开始肠内营养治疗，2tJl均接受2周的治疗，观察2组患者治疗前后血常规、白蛋白等指标及炎症细胞因子水平的差异，比较2组患者血淀粉酶恢复时间和并发症发生率的差异。结果2组患者治疗前红细胞计数（red blood cell count，RBC）、白蛋白（albumin，ALB）和前白蛋白（prealbumin，PA）水平无明显差别，治疗后，两组患者的上述指标均较治疗前增高，且观察组增高更明显（P〈0．05）；2组患者治疗前白细胞介素6（IL-6）、超敏c反应蛋白（hs-cRP）和肿瘤坏死因子α（TNF-α）水平无明显差别，治疗后2组患者的上述指标均较治疗前降低，且观察组降低更明显（P〈0．05）；观察组患者腹腔感染和多器官功能障碍综合征（MODS）发生率明显低于常规治疗组（P〈0．05）；观察组治疗后血淀粉酶恢复时间均较常规治疗组短（P〈0．05）。结论EEN对重症急性胰腺炎有较好的治疗效果，可明显改善患者的营养状况和免疫功能，减少并发症，具有临床应用价值。

Objective To investigate the effect of early enteral nutrition （EEN） in the treatment of severe acute pancreatitis （SAP）. Methods Contrastive analysis was used to analysis the clinical data of 65 patients with severe acute pancreatitis treated in our hospital from January 2010 to December 2015. The patients were divided into the routine group （35 cases） and the observation group （35 cases）. In the conventional treatment group, the parenteral nutrition was first implemented in the relatively stable condition of the patient＇s internal environment, and the enteral nutrition was started in the stable state of life cycle, such as 7d; In the observation group, the patients were treated with enteral nutrition therapy in the condition of vital signs, water electrolyte and acid-base balance, which was about 72h ＇after admission. Two groups all received two weeks of treatment. Analysed the differences between the two groups in complete blood count, albumin/pre albumin, and Inflammatory factors before and after the treatment, Compared the time of serum amylase to normal standard and incidence of complications between two groups. Results There were no significant differences in the levels of Red blood cell count （RBC）, albumin （Alb） and pre albumin （PA） between the two groups before treatment. After treatment, the indexes of the two groups were significantly higher than before treatment, and the observation group was significantly higher （P〈O.05）; There were no significant differences in the levels of Interleukin-6 （IL-6）, high sensitive C reactive protein （hs-CRP） and tumor necrosis factor alpha （TNF- alpha） before treatment in the two groups. After treatment, the indexes of the two groups were lower than that before treatment, and the observation group decreased more significantly （P〈0.05）; The incidence of infection and MODS in the observation group was significantly lower than that in the routine group, the difference was statistically significant （P〈O.05）; The recovery time of blood amylase in the observation group was shorter than that in the conventional treatment group, the difference was statistically significant （P〈0.05）. Conclusion Early enteral nutrition can significantly improve the nutritional status and immune function in patients with severe acute pancreatitis, reduce complications, which has the value of clinical application.