中度重症急性胰腺炎患者早期经胃管和空肠管行肠内营养治疗的疗效对比

Comparison of the effects of early nasogastric versus nasojejunal feeding in patient with moderately severe acute pancreatitis

目的观察中度重症胰腺炎患者早期经胃管和空肠管行肠内营养治疗的临床疗效。方法选取2017年2月至2018年2月入我院消化内科的MSAP患者共56例,随机分为胃管组(NG组,29例)和空肠管组(NJ组,27例)。入院后进行急性胃肠损伤分级评估,予常规治疗,液体复苏,必要时血液净化等治疗。两组患者均于入院后48～72 h内置入胃管或空肠管,急性胃肠损伤分级Ⅰ～Ⅱ级患者置管后即启动肠内营养。观察入院24 h及发病1周时CRP,入院1周的CTSI评分,肠内营养达标时间,肠内营养持续时间,腹痛缓解时间,住院时间,腹胀、腹泻、腹痛加剧和反流等喂养不良反应,胰腺坏死合并感染的发生率,器官衰竭并发症、手术及死亡等不良事件。结果病因中胆源性占48. 2%,高脂血症性占32. 1%,酒精性占12. 5%。NJ组和NG组的EN达标时间、EN持续时间和总体喂养不良反应发生率比较差异无统计学意义(P> 0. 05),但NG组腹胀、反流的发生率高于NJ组(P <0. 05)。器官衰竭中ARDS发生率最高,其次为急性肾功能不全和休克。NJ组和NG组器官衰竭和胰腺坏死合并感染发生率比较差异无统计学意义(P> 0. 05)。此外,两组入院24 h CRP、入院1周CRP、入院1周CTSI、住院时间比较差异无统计学意义(P> 0. 05)。结论与NJ相比,经NG行早期肠内营养治疗MSAP患者具有短时、高效、安全的特点,并可早期实施,此外,MSAP患者启动EN前应进行胃肠道功能的评估。

Objective To observe the efficacy of early enteral feeding through nasogastric and nasojejunal feeding in patients with moderately severe acute pancreatitis. Methods Totally 56 patients admitted to department of gastroenterology of our hospital from February 2017 to February 2018 were randomly divided into nasogastric group（ NG group,n = 29） and nasojejunal group（ NJ group,n = 27）. Acute gastrointestinal damage was assessed after admis-sion,and routine treatment,liquid recovery,and the necessary blood purification were performed. Patients were implanted with nasogastric tube or jejunum tube at 48 ～ 72 h after admission. Enteral nutrition was conducted immediately in patients with acute gastrointestinal injury grade Ⅰ ～ Ⅱ. The 24 h CRP,1-week CRP,1-week CTSI score,time of achieving standard and duration of enteral nutrition,time of relieving abdominal pain and hospital stay,and adverse reaction of enteral nutrition（ including abdominal distension,diarrhea,intensified abdominal pain and reflux） were observed.M oreover,the incidences of pancreatic necrotic infection,organ failure,death and other adverse events were also recorded. Results According to the pathogenesis,biliary pancreatitis counted for 48. 2%,hyperlipidemia pancreatitis counted for 32. 1%,and alcoholic pancreatitis accounted for 12. 5%. There was no significant difference in the time of achieving standard or duration of enteral nutrition or the incidence of adverse reactions in overall feeding between the two groups（ P〈0. 05）,but the incidence of abdominal distension and reflux in NG group was higher than that in NJ group（ P〈0. 05）. The incidence of ARDS was the highest（ P〈0. 05）,which were followed by acute renal insufficiency and shock（ P〈0. 05）. There was no significant difference in the incidences of organ failure or pancreatic necrotic infection between the two groups（ P〈0. 05）. In addition,there was no significant difference in the 24 h CRP,1-week CRP,1 week CTSI or the time of hospital stay. Conclusion Compared with nasojejunal tube feeding,early enteral nutrition through nasogastric tube for M SAP patients is rapid,excellent and safe,and can be implemented early. In addition,the gastrointestinal function of M SAP patients should be evaluated before receiving enteral nutrition.