改良口-十二指肠镜置管治疗重症急性胰腺炎疗效及营养效果分析

Analysis on the therapeutic effect and nutritional effect of modified oral-duodenoscopic catheterization in the treatment of severe acute pancreatitis

目的探讨重症急性胰腺炎患者鼻空肠营养管放置方法的选择及其营养效果的分析性研究,间接评估其对预后的影响。方法筛选我院2014年4月～2018年4月重症急性胰腺炎患者117例随机分为A组(改良口-十二指肠镜)40例、B组(鼻-胃镜直视下)38例、C组(X线透视下)39例,比较三组置管操作时间、操作成功率、操作相关并发症及副作用发生率、患者置管后2周营养效果评估(血红蛋白HB、血清白蛋白ALB、前白蛋白PA)。结果①A组与B组置管操作时间和置管成功率比较差异无统计学意义(P>0.05),且置管操作时间均显著短于C组(P<0.01),操作成功率均高于C组(P<0.05)。②A组置管操作相关并发症及副作用发生率和疾病相关死亡率低于B组(P<0.05),且A组和B组低于C组(P<0.01)。③三组操作后2周营养效果(HB、ALB、PA)较置管前均有所改善(P<0.01)。且PA指标A组和B组、A组和C组、B组与C组相比均有显著改善(P<0.01)。结论改良口-十二指肠镜导丝引导下鼻空肠营养管置管技法是重症急性胰腺炎患者置管的最佳选择,置管操作时间短、成功率高、并发症及副作用小,营养效果佳,更易被患者接受。

Objective To investigate the analytical study of the selection of the placement method of nasal jejunal feeding tube in the patients with severe acute pancreatitis and its nutritional effects,and to evaluate its impact on prognosis indirectly.Methods A total of117patients with severe acute pancreatitis in our hospital were screened and were randomly divided into group A(modified oral-duodenoscopy)of40cases,group B(under direct nasal-gastroscopy)of38cases,and group C(under X-ray)of39cases.The catheterization operation time,operation success rate,incidence rate of operation-related complications and side effects,and the evaluation of nutritional effects2weeks after catheterization(hemoglobin HB,serum albumin ALB,prealbumin PA)were compared between the three groups.Results①There was no statistically significant difference in catheterization operation time and catheterization success rate between group A and group B(P>0.05),and the catheterization operation time in group A and B was significantly shorter than that in group C(P<0.01).The success rate of operation was higher than that in group C(P<0.05).②The incidence rate of operation-related complications and side effects and disease-related mortality in group A were lower than those in group B(P<0.05),and those in group A and group B were lower than those in group C(P<0.01).③The nutritional effects(HB,ALB,PA)at2weeks after operation in the three groups were improved compared with those before catheterization(P<0.01).There were significant improvements in PA indicators between group A and B,group A and C,and group B and C(P<0.01).Conclusion Modified oral-duodenoscopic guidewire-guided nasal jejunal feeding tube placement technique is the optimal choice for catheterization in the patients with severe acute pancreatitis.The catheterization operation time is short,the success rate is high,the complications and side effects are minor,the nutritional effect is favorable,and it is more easily to be accepted by the patient.