早期肠内营养联合急腹症Ⅲ号对重症胰腺炎患者临床症状及胃肠道功能指标的影响

Effect of early enteral nutrition combined with acute abdomen Ⅲ on clinical symptoms and gastrointestinal function indexes in patients with severe acute pancreatitis

目的探讨早期肠内营养(enteral nutrition,EN)辅以急腹症Ⅲ号治疗重症胰腺炎(severe acute pancreatitis,SAP)的疗效及对胃肠道相关指标的影响。方法纳入杭州市中医院急诊科在2014年7月—2018年6月收治的68例SAP患者,按照随机数字表法平均分为观察组和对照组(各34例),对照组于入ICU后24 h内给予肠内营养治疗,观察组在对照组基础上辅以本院自制的中药制剂急腹症Ⅲ号;2组患者均连续应用7 d,比较2组患者临床疗效、临床症状缓解时间、ICU住院时间,胃肠道功能、炎症指标及并发症情况。结果观察组临床有效率为91.18%,与对照组相比差异有统计学意义(P<0.05);观察组临床症状缓解时间、ICU住院时间明显短于对照组(均P<0.05);治疗后2组患者血清D-乳酸、ET、DAO、胃肠功能评分及尿乳果糖/甘露醇水平均出现不同程度下降(均P<0.05),观察组在D-乳酸、ET、DAO、胃肠功能评分及尿乳果糖/甘露醇水平低于对照组(均P<0.05);治疗后观察组血淀粉酶(AMY)、CRP、TNF-α及APACHE-Ⅱ评分明显低于对照组,IL-10水平高于对照组,差异具有统计学意义(均P<0.05);2组患者治疗后28 d病死率及并发症发生率比较差异无统计学意义(均P>0.05)。结论 EN联合急腹症Ⅲ号治疗SAP疗效显著,能够缓解患者临床症状,保护胃肠道功能,减轻炎症反应。

Objective To investigate the efficacy of early enteral nutrition(enteral nutrition, EN) combined with acute abdomen Ⅲ in the treatment of severe pancreatitis(severe acute pancreatitis, SAP) and its influence on gastrointestinal tract related indicators. Methods A total of 68 patients with SAP admitted to the emergency department of Hangzhou Traditional Chinese Medicine Hospital from July 2014 to June 2018 were randomly divided into observation group and control group(34 cases each) according to the random number table. The control group was placed in the ICU. Enteral nutrition was given within 24 hours. The observation group was supplemented with the self-made traditional Chinese medicine preparation acute abdomen Ⅲ on the basis of the control group. The two groups of patients were continuously used for 7 days. The clinical efficacy and clinical symptom relief time, ICU stay time, gastrointestinal function, inflammation index and complications of the two groups were compared. Results The clinical effective rate of the observation group was 91.18%, the difference was statistically significant compared with the control group(all P<0.05), and ICU hospitalization. The time was significantly shorter than that of the control group(all P<0.05). After treatment, serum D-lactic acid, ET, DAO, gastrointestinal function score and urinary lactulose/mannitol levels decreased in different degrees(all P<0.05). The D-lactide, ET, DAO, gastrointestinal function scores and urinary lactulose/mannitol levels were lower in the control group than in the control group(all P<0.05). The AMY, CRP, TNF-α and APACHE-Ⅱ scores in the observation group were significantly lower after treatment. In the control group, IL-10 levels were higher than the control group, the difference was statistically significant(all P<0.05);while the 28 d mortality rate and complication rate in the two groups after treatment showed no statistical difference(all P>0.05). Conclusion EN combined with acute abdomen Ⅲ treatment of SAP has significant curative effect, which would alleviate clinical symptoms, protect gastrointestinal function and reduce inflammation.