早期肠内营养对重症急性胰腺炎患者血清内毒素水平和肠黏膜通透性的影响

Effect of early enteral nutrition on serum endotoxin and intestinal permeability in patients with severe acute pancreatitis

目的 研究早期肠内营养（ＥＮ）对重症急性胰腺炎患者血清内毒素和肠黏膜通透性的影响。方法 选取７０例重症急性胰腺炎患者为研究对象，采用随机数字表法分为肠外营养（ＰＮ）和ＥＮ组，每组３５例。ＰＮ组给予ＰＮ干预，ＥＮ组则给予ＥＮ干预。对比干预前、干预１周和干预２周患者血清内毒素水平、尿液乳果糖排泄率／甘露醇排泄率比值及治疗前后炎性因子水平。结果 干预前两组血清内毒素水平及尿液乳果糖排泄率／甘露醇排泄率比值差异均无统计学意义（ｔ＝０．２７４，Ｐ＝０．４５２；ｔ＝０．０３５，Ｐ＝０．８８５），干预１周和干预２周后ＥＮ组血清内毒素水平及尿液乳果糖排泄率／甘露醇排泄率比值均远低于ＰＮ组（ｔ＝９．０２４、１０７６１，Ｐ＝００００、０．０００；ｔ＝６．９３５、８．３５８，Ｐ＝０．０００、０．０００）；治疗后，ＥＮ组ＴＮＦ-α、ＩＬ-１β、ＩＬ-６、ＩＬ-８水平均低于ＰＮ组（ｔ＝１２．６７４、１０．３１８、９．７５４、８．３０７，Ｐ＝０．０００、０．０００、０．０００、０．００２）。结论 ＥＮ对重症急性胰腺炎患者血清内毒素和肠黏膜通透性的影响大，与ＰＮ比，可更好促进血清内毒素的清除，降低肠黏膜通透性，值得推广。

0bjective To study the effect of early enteral nutrition （EN） on the serum endotoxin and intestinal permeability in patients with severe acute pancreatitis （SAP）. Methods Seventy patients with SAP were selected as study objects ,and they were divided into parenteral nutrition （PN） group and EN group according to the random number table method, with 35 cases in each group. The PN group was given PN intervention, while the EN group was given EN intervention. The levels of serum endotoxin and the ratio of the excretion rates of urinary lactulose and mannitol excretion before and after 1 week and 2 weeks of intervention, and the levels of inflammatory factors before and after treatment were measured. Results Before intervention, the levels of serum endotoxin and the ratio of the excretion rates of urinary lactulose and mannitol excretion had no statistically significant differences between the two groups （t = 0. 274, P = 0, 452;t = 0. 035, P = 0. 885 ）. After 1 week and 2 weeks of intervention, the levels of serum endotoxin and the ratio of the excretion rates of urinary lactulose and mannitol excretion in the EN group were significantly lower than those in the PN group （ t = 9. 024,10,761, P = 0. 000, 0. 000 ; t = 6. 935,8. 358, P = 0.000, 0. 000）. After treatment, the levels of TNF-α、IL-1β、IL-6、IL-8in the EN group were significantly lower than those in the PN group （t=12.674,10.318,9.754,8.307,P=0. 000,0. 000,0. 000,0. 002 ）. Conclusion EN has significant influence on the serum endotoxin and intestinal permeability in patients with SAP, and compared with PN,EN can promote the clearance of serum endotoxin, reduce the permeability of intestinal mucosa, and it is worth promoting.