肠内营养耐受性定时评估管理对重症急性胰腺炎患者的影响

Influence of timing assessment management of enteral nutrition tolerance on patients with severe acute pancreatitis

目的探讨肠内营养耐受性定时评估管理对重症急性胰腺炎患者的影响。方法选择2016年6—12月在我院ICU接受治疗的重症急性胰腺炎患者40例作为对照组,选择2017年1—6月在我院ICU治疗的重症急性胰腺炎患者42例作为观察组,所有患者均于入院后48h内开始进行早期肠内营养,对照组进行常规肠内营养观察及处理,观察组采用自行制定的肠内营养耐受性定时评估管理方案对患者进行观察及处理。比较两组患者肠内营养期间不耐受症状及并发症发生情况,肠内营养治疗1,2周后营养指标以及免疫功能相关指标变化,患者目标营养量达标时间、机械通气时间、ICU停留时间。结果观察组肠内营养不耐受率明显低于对照组,目标营养量达标时间短于对照组,差异均有统计学意义(P<0.05);肠内营养治疗1,2周后观察组血清蛋白水平、T淋巴细胞亚群(除肠内营养治疗1,2周后CD8^+外)及免疫球蛋白水平(除肠内营养治疗2周后IgG,IgM外)均明显高于对照组,差异有统计学意义(P<0.05);观察组机械通气时间及ICU停留时间均短于对照组,差异有统计学意义(P<0.05);两组治疗过程中均无死亡病例,观察组多器官功能衰竭、胰腺坏死等并发症发生率低于对照组,但差异无统计学意义(P>0.05)。结论肠内营养耐受性定时评估管理能使医护人员准确评价耐受性,采取规范化处置方案,有利于降低不耐受率,进一步改善患者的营养状况及免疫功能,对改善临床预后具有重要价值。

Objective To discuss the effect of timing assessment management of enteral nutrition tolerance on patients with severe acute pancreatitis.Methods To selected 40 cases of patients with severe acute pancreatitis who were treated in the ICU of our hospital from June 2016 to December 2016 as the control group.We selected 42 patients with severe acute pancreatitis who were treated in the ICU of our hospital from January 2017 to June 2017 as the observation group.All of these patients started early enteral nutrition within 48 hours after admission.The control group was given routine enteral nutrition observation and treatment.The observation group was observed and treated by self-developed timing assessment management of enteral nutrition tolerance.We compared the symptoms and complications of intolerance during enteral nutrition between the two groups,the changes in nutritional indicators and immune function related indexes after 1 week and 2 weeks of enteral nutrition treatment,the time to reach the targeted nutrition,mechanical ventilation time,and ICU residence time.Results The enteral nutrition intolerance rate of the observation group was significantly lower than that of the control group,the time to reach the targeted nutrition was shorter than that in the control group,and the difference was statistically significant(P<0.05).After 1 week and 2 weeks of enteral nutrition treatment,serum protein levels,T lymphocyte subsets(except for CD8+at 1 week and 2 weeks after the enteral nutrition treatment),and immunoglobulin levels(except for IgG and IgM at 2 weeks after the enteral nutrition treatment)were significantly higher than that of the control group,and the difference was statistically significant(P<0.05).The mechanical ventilation time and ICU residence time in the observation group were shorter than those in the control groupobservation group,and the difference was statistically significant(P<0.05).There were no deaths in the treatment of the two groups.The incidence of complications such as multiple organ failure and pancreatic necrosis in the observation group was lower than that in the control group,however,the difference was not statistically significant(P>0.05).Conclusion The timing assessment and management of enteral nutrition tolerance can enable the medical staff to assess tolerance accurately.Therefore,they can adopt standardized treatment plans,which is beneficial to reduce the intolerance rate,and further improve the nutritional status and immune function of patients.As a result,such kind of treatment has important value in improving clinical prognosis.