早期肠内营养治疗高脂血症性急性重症胰腺炎的安全性及疗效观察

Safety and effect of early enteral nutrition on hyperlipidemia-induced severe acute pancreatitis

目的探讨高脂血症性急性重症胰腺炎(hyperlipidemia-induced severe acute pancreatitis,HLSAP)患者行早期肠内营养治疗的安全性及疗效。方法 HLSAP患者68例,入院确诊72h后行肠内营养治疗者36例为延迟营养组,入院确诊72h内行肠内营养治疗者32例为早期营养组,比较2组患者腹痛缓解时间、血及尿淀粉酶恢复时间,治疗2周后血清总蛋白、白蛋白和血清C反应蛋白水平变化、急性生理性及慢性健康状况评分Ⅱ(Acute Physiology And Chronic Health Evaluation ScoreⅡ,APACHEⅡ)评分、住院时间、并发症发生率等。结果早期营养组腹痛缓解时间[(3.6±1.2)d]、血淀粉酶恢复时间[(6.0±1.0)d]、尿淀粉酶恢复时间[(17.1±2.2)d]和住院时间[(28.2±2.4)d)]短于延迟营养组[(5.9±1.4)d、(9.5±1.4)d、(19.7±1.8)d、(33.3±3.9)d)](P<0.05),治疗2周后血清总蛋白[(57.7±3.4)g/L]、白蛋白[(25.9±2.4)g/L]高于延迟营养组[(51.9±2.6)g/L、(21.1±2.9)g/L](P<0.05),治疗后APACHEⅡ评分(7.1±2.5)和血清C反应蛋白水平[(40.1±20.7)mg/L]低于延迟营养组[(8.7±3.1)分,(104.3±21.9)mg/L](P<0.05);延迟营养组并发症发生率(66.7%)、病死率(19.4%)与早期营养组(43.8%,15.6%)比较差异均无统计学意义(P>0.05)。结论 HLSAP患者入院确诊72h内进行肠内营养治疗安全、有效,可加速患者康复,缩短住院时间。

Objective To investigate the safety and efficacy of early enteral nutrition therapy for hyperlipidemia-induced severe acute pancreatitis（HLSAP）.Methods Sixty-eight patients with HLSAP were divided 36 patients receiving enteral nutrition 72 hafter admission（delayed nutrition group）and 32 patients receiving enteral nutrition within 72 hafter admission（early nutrition group）.The abdominal pain relief time,hematuria amylase recovery time,serum total protein level,albumin level and serum C-reactive protein level after two-week treatment,Acute Physiology and Chronic Health Evaluation ScoreⅡ（APACHEⅡ）score,hospitalization stay and incidence of complications were compared between two groups.Results The abdominal pain relief time（（3.6±1.2）d）,blood amylase recovery time（（6.0±1.0）d）,urinary amylase recovery time（（17.1±2.2）d）and hospitalization stay（（28.2±2.4）d）in early nutrition group were significantly shorter than those in delayed nutrition group（（5.9±1.4）,（9.5±1.4）,（19.7±1.8）,（33.3±3.9）d）（P〈0.05）.The serum total protein and albumin were significantly higher in early nutrition group（（57.7±3.4）,（25.9±2.4）g/L）than those in delayed nutrition group（（51.9±2.6）,（21.1±2.9）g/L）after two-week treatment（P〈0.05）.The APACHEⅡ score and serum C-reactive protein level were significantly lower in early nutrition group（7.1±2.5,（40.1±20.7）mg/L）than those in delayed nutrition group（8.7±3.1,（104.3±21.9）mg/L）after treatment（P〈0.05）.There were no significant differences in the incidence of complications and fatality between delayed nutrition group（66.7%,19.4%）and early nutrition group（43.8%,15.6%）（P〉0.05）.Conclusion Enteral nutrition therapy within 72 hafter admission is safe and effective for HLSAP,which can accelerate the recovery and shorten the hospitalization stay.