早期低热卡与高热卡营养治疗高脂血症性重症急性胰腺炎的临床疗效比较

Comparison of clinical efficacy between early low and high enteral nutrition(EN) administration in the early treatment of hyperlipidemic severe acute pancreatitis

目的:探讨高脂血症性胰腺炎(HLAP)早期高热卡与低热卡肠内营养对其并发症及预后的比较,来评估不同热卡的肠内营养的疗效。方法:将我科收治的高HLAP病人,随机分入早期低热卡与高热卡营养治疗组,分别在早期(48 h)内分别给予高热卡和低热卡的肠内营养支持治疗,记录两组病人血脂、炎症指标变化水平、肠内营养不耐受发生率及住院时间、ICU时间、器官功能发生率、死亡率、胰腺坏死组织发生率等。结果:我科2014年1月至2017年6月共收治HLAP病人48例。在EN开始的前两天内,LC的病人血脂呈逐步降低趋势,两组血脂水平在EN开始后第三天分别为2.3(1.7-3.4)mmol/L vs 5.2(2.9-6.1)mmol/L,P=0.05。LC组的ICU天数明显小于HC组,MODS发生率、死亡率两组之间无明显差异。IPN发生率LC稍高,但无统计学意义。结论:对于HTG-AP病人,低热卡-高蛋白营养方式可使病人因正氮平衡而增加瘦体重,同时因热卡不足而消耗体脂肪;利于病人病情的恢复,是一种有效的营养支持方案。

Objective： This study aimed to compare the effects of high versus low calorie early enteral nutrition（EEN） administration on the complications and prognosis of hyperlipidemic acute pancreatitis（HLAP） patients. Methods： In this study, HLAP patients were randomly divided into high calorie EEN group and low calorie EEN group. The nutritional support was carried out within 48 h at patients＇ admission. The serum lipid levels, inflammatory parameters, the incidence of EN intolerance, hospitalization duration, ICU duration, the incidence of organ failure and infected pancreatic necrosis as well as mortality rate were recorded and compared between two groups. Results ：48 patients with diagnosis of HLAP were included in this study from January 2014 to June 2017. In the first two days, the serum lipid levels of patients in low-calorie group decreased gradually. The serum lipid levels of the two groups were 2.3（1.7-3.4） mmol/L versus 5.2（2.9-6.1） mmol/L（P = 0.05） respectively on third day after EN administration. There was no significant difference in the incidence of MODS and mortality rate between the two groups while the ICU duration of low-calorie group was significantly shorter than that in high-calorie group. The incidence of IPN in low-calorie group showed an elevated trend but there was no statistical significance. Conclusion ：For HLAP patients, low calorie-high protein nutrition supply could benefit the patients to gain lean body weight due to the positive nitrogen balance, and to consume body fat due to the deficiency of calories. It is an effective nutrition support strategy for the patients＇ recovery.