超早期和早期肠内营养对老年肥胖重度急性胰腺炎疗效的对比研究

Comparative Study on Ultra-early and Early Enteral Nutrition Support in Elderly Obese Patients With Severe Acute Pancreatitis

背景:早期给予肠内营养可改善重度急性胰腺炎(SAP)患者肠黏膜屏障、减少感染和并发症;但何时开始肠内营养目前仍存在争议。目的:探讨不同肠内营养开始时间对老年肥胖SAP患者的治疗效果。方法:回顾性分析接受超早期肠内营养(A组)和早期肠内营养(B组)患者的临床疗效、住院时间、住院费用和并发症发生率以及治疗前后血清炎症因子水平。结果:A组总有效率高于B组,但差异无统计学意义(90.9%对79.2%,χ~2=1.227,P>0.05)。与B组相比,A组治疗后血、尿淀粉酶恢复正常时间以及住院时间显著缩短,住院费用明显降低(P<0.05);腹痛、腹胀、呕吐和发热症状消失时间显著缩短(P<0.05);血清炎症因子IL-6、TNF-α和CRP水平显著降低(P<0.05);感染率发生率显著降低(P<0.05)。结论:与早期肠内营养组相比,超早期肠内营养对于老年肥胖SAP患者疗效更佳,且具有住院时间较短、费用更低的优点。

Early administration of enteral nutrition can improve intestinal mucosal barrier in patients with severe acute pancreatitis(SAP),reduce infection and complications;but when should the enteral nutrition be started is still controversial.Aims:To study the effect of different initiation time of enteral nutrition on elderly obese patients with SAP.Methods:The clinical efficacy,hospitalization time,hospitalization cost and the risk of complication were analyzed retrospectively in the two groups of patients with either ultra-early enteral nutrition(group A)or early enteral nutrition(group B),as well as the serum levels of inflammatory cytokines before and after treatment.Results:No significant difference in total effective rate was found between group A and group B(90.9%vs.79.2%,χ2=1.227,P>0.05).Compared with group B,the recovery time of blood and urine amylase,and hospitalization time in group A were significantly shortened and the cost of hospitalization was significantly decreased(P<0.05).The time of abdominal pain,bloating,vomiting and fever in group A was significantly shorter than that in group B(P<0.05).After14days of treatment,levels of IL-6,TNF-αand CRP in group A were significantly lower than those in group B(P<0.05).The incidence of infection was significantly lower in group A than in group B(P<0.05).Conclusions:Compared with early enteral nutrition group,ultra-early enteral nutrition for elderly obese patients with SAP has better efficacy,and has a shorter hospital stay and lower hospitalization cost.