早期肠内营养联合谷氨酰胺和低分子肝素治疗老年重症胰腺炎患者的效果

Clinical effect of early enteral nutrition combined with glutamine and low molecular heparin on severe pancreatitis in elderly patients

目的探讨早期肠内营养联合谷氨酰胺和低分子肝素治疗老年重症胰腺炎的效果。方法选取2015年1月至2017年1月重庆三峡中心医院收治的老年重症胰腺炎患者88例,完全随机分为观察组(44例)和对照组(44例),均给予禁食、胃肠减压等基础治疗。对照组给予奥美拉唑钠静脉滴注,2次/d,注射用生长抑素慢速冲击注射。观察组给予早期肠内营养支持联合谷氨酰胺和低分子肝素干预。2组疗程均为10 d。比较2组腹痛、腹胀、肠鸣音、排便、体温恢复时间,4周内急性呼吸窘迫综合征(ARDS)和多器官功能障碍综合征(MODS)发生率及病死率,治疗前和治疗后72 h血气指标及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,治疗后72 h血清中高迁移率族蛋白B1(HMGB1)和晚期糖基化终末产物受体(RAGE)水平。结果 治疗后,观察组腹痛、腹胀、排便、肠鸣音及体温恢复时间均明显短于对照组(均P<0.01)。观察组4周内ARDS和MODS发生率均明显低于对照组[11.4%(5/44)比31.8%(14/44)、13.6%(6/44)比36.4%(16/44)](均P<0.05);2组病死率比较,差异无统计学意义(P>0.05)。观察组治疗后血氧分压和动脉血氧饱和度明显高于对照组[(90±10)mmHg(1mmHg=0.133 kPa)比(76±9)mmHg、(97±10)%比(92±10)%],动脉血二氧化碳分压和APACHEⅡ评分明显低于对照组[(45±5)mmHg比(59±6)mmHg、(5.0±O.6)分比(6.5±0.8)分](均P<0.01)。观察组治疗后血清中HMGB1和RAGE水平明显低于对照组[(21±3)μg/L比(37±4)μg/L、(5.3±0.6)μg/L比(7.4±0.9)μg/L](均P<0.01)。结论早期肠内营养联合谷氨酰胺和低分子肝素治疗老年重症胰腺炎疗效明显,可能与其下调血清中HMGB1和RAGE水平有关。

Objective To observe the clinical effect of early enteral nutrition combined with glutamine and low molecular heparin on severe pancreatitis in elderly patients. Methods A total of 88 elderly patients with severe pancreatitis admitted from January 2015 to January 2017 in Chongqing Three Gorges Central Hospital were randomly divided into observation group（44 cases） and control group （44 cases）. All patients had basic treatments of fasting and gastrointestinal decompression. The control group had intravenous drip of omeprazole sodium 2 times/d and slow injection of somatostatin. The observation group was treated by early enteral nutrition combined with glutamine and low molecular heparin. The course of treatments was 10 d. Recovery time of abdominal pain, abdominal distention, bowel gurgling sound, defecation and body temperature, incidence rates of acute respiratory distress syndrome（ARDS） and multiple organ dysfunction syndrome（MODS） in 4 weeks, blood gas indexes and score of the acute physiology and chronic health evaluation 11 （APACHE） before and 72 h after treatment, serum levels of high mobility group box B1 （HMGB1） and receptor for advanced glycation end products（RAGE） 72 h after treatment were analyzed. Results Recovery time of abdominal pain, abdominal distention, bowel gurgling sound, defecation and body temperature in observation group were significantly shorter than those in control group （P 〈0.01 ）. Incidence rates of ARDS and MODS in 4 weeks in observation group were siguificantly lower than those in control group[ 11.4% （5/44） vs 31.8% （ 14/44）, 13.6% （6/44） vs 36.4% （16/44） （P 〈0.05 ）. After treatment, arterial oxygen partial pressure and saturation in observation group were signifieantly higher than those in control group [ （90 ± 10） mmHg vs （76 ±9 ） mmHg, （97 ± 10） % vs （ 92 ±10） % ] （ P 〈 0.01 ） ; arterial partial pressure of carbon dioxide and the APACHE II score in observation group were significantly lower than those in control group [ （45 ± 5 ） mmHg vs （ 59 ± 6 ） mmHg, （ 5.0 ± 0.6 ） points vs （ 6.5 ± 0.8 ） points ] （ P 〈 0. 01 ） ; serum levels of HMGB1 and RAGE in observation group were significantly lower than those in control group [（21±3）μg/Lvs （37±4）μg/L, （5.3±0.6）μg/Lvs （7.4±0.9）μg/L]（P〈0.01）. Conclusion Early enteral nutrition combined with glutamine and molecular heparin can reduce HMGB1 and RAGE; it is effective in treating severe pneumonia in elderly patient.