肠内外联合营养治疗老年人急性胰腺炎伴高脂血症

Enteral and parenteral nutrition in the treatment of elderly patients with acute pancreatitis complicated with hyperlipidemia

目的 研究肠内营养联合肠外营养支持对老年人急性胰腺炎伴高脂血症的临床治疗效果的影响.方法 选取老年急性胰腺炎伴高脂血症患者50例,采用随机数字表法将患者分为观察组（n=25）与对照组（n=25）,观察组患者给予肠内营养联合肠外营养支持,对照组患者给予肠外营养支持,比较两组患者的营养支持效果.结果 两组患者营养支持第8天血、尿淀粉酶分别为（69±11）U/L和（184±24）U/L、（72±21）U/L和（177±21）U/L,第4天水平分别为（278±32）U/L和（884±108）U/L、（271±31）U/L和（863±119）U/L,第1天水平分别为（574±57）U/L和（2278±321）U/L、（593±61）U/L和（2311±343）U/L,其中第8天水平显著低于第4天（观察组：t=30.883,P=0.000,t=31.636,P=0.000;对照组：t=26.574,P=0.000,t=28.385,P=0.000）,第4天血、尿淀粉酶显著低于第1天（观察组：t=22.641,P=0.000,t=20.580,P=0.000;对照组：t=23.529,P=0.000,t=19.942,P=0.000）;对照组第8天白蛋白和前白蛋白水平分别为（31.49±3.17）g/L和（90.51±20.07）mg/L,观察组为（33.49±3.08）g/L和（103.73±22.89）mg/L,组间差异均有统计学意义（t=2.262,P=0.028;t=2.171,P=0.035）;观察组第8天总胆固醇和甘油三酯水平分别为（2.81±0.81）mmol/L和（2.74±0.24）mmol/L,对照组分别为（2.93±0.73）mmol/L和（2.67±0.31）mmol/L,均显著高于第1天（观察组：t=7.798,P=0.000,t=3.371,P=0.003;对照组：t=8.079,P=0.000,t=2.560,P=0.039）.结论 在老年人急性胰腺炎伴高脂血症治疗过程中,给予肠内营养联合肠外营养支持,能够有效改善患者的临床症状与体征指标,促进患者的病情缓解.

Objective To study the effect of enteral nutrition combined with parenteral nutrition in the treatment of elderly patients with acute pancreatitis complicated with hyperlipidemia .Methods 50 patients with acute pancreatitis and hyperlipidemia were enrolled ,and they were randomly divided into observation group （n=25） and control group （n=25） according to the digital table .The patients in the observation group were given enteral nutrition combined with parenteral nutrition , the control group was treated with parenteral nutrition support , The effect of nutrition support was compared between the two groups .Results The blood and urine amylase levels in the two groups after 8d were （69 ±11）U/L and （184 ±24）U/L,（72 ±21）U/L and （177 ±21）U/L,respectively,while the levels were （278 ±32）U/L and （884 ±108）U/L,（271 ±31）U/L and （863 ±119）U/L after 4d,which after 1d were （574 ±57）U/L and （2278 ±321）U/L,（593 ±61）U/L and （2311 ±343）U/L,respectively,and the levels after 8d were significantly lower than those after 4d （ the observation group：t=30.883,P=0.000;t=31.636,P=0.000.The control group：t=26.574,P=0.000,t=28.385,P=0.000）,and the levels after 4d were significantly lower than those after 1d （the observation group：t=22.641,P=0.000;t=20.580,P=0.000.The control group：t=23.529,P =0.000,t =19.942,P =0.000）.The albumin and prealbumin of the control group after 8d were （31.49 ±3.17）g/L and （90.51 ±20.07） mg/L,respectively,which of the observation group were （33.49 ± 3.08）g/L and （103.73 ±22.89）mg/L,respectively,there were statistically significant differences between the two groups （t=2.262,P=0.028;t=2.171,P=0.035）.The total cholesterol and triglyceride levels in the observation group were （2.81 ±0.81） mmol/L and （2.74 ±0.24） mmol/L,respectively,which in the control group were（2.93 ±0.73）mmol/L and （2.67 ±0.31）mmol/L,respectively,which were significantly higher than those after 1d （the observation group：t=7.798,P=0.000,t=3.371,P=0.003;the control group：t=8.079,P=0.000,t =2.560,P=0.000）.Conclusion For the acute pancreatitis elderly patients with hyperlipidemia ,the enteral nutrition combined with parenteral nutrition support can effectively improve the patients ＇clinical symptoms and signs ,promote the remission.