经胃镜介导放置空肠营养管肠内营养与全肠外营养支持在急性胰腺炎治疗中的应用效果比较

A comparison of effects of enteral nutrition by endoscopic jejunal feeding tube placement versus total parenteral nutrition on patients with acute pancreatitis

目的比较经胃镜介导放置空肠营养管肠内营养(EN)与全肠外营养支持(TPN)在急性胰腺炎中的应用效果。方法选取中部战区空军医院2012年3月至2019年12月收治的急性胰腺炎患者60例,按照随机数字表法分为对照组和观察组,每组30例。对照组患者采取全肠外营养支持,观察组患者采用经胃镜介导放置空肠营养管肠内营养支持。比较两组患者的营养水平[血清白蛋白(ALB)、血清前白蛋白(PA)水平]、康复质量[急性生理与慢性健康评分(ApacheⅡ)]、血淀粉酶水平、C反应蛋白(CRP)水平、临床疗效及并发症发生情况。结果治疗后14 d,观察组ALB、PA水平高于对照组(P<0.05);治疗后7、14 d,观察组ApacheⅡ评分低于对照组(P<0.05);治疗后14 d,观察组血淀粉酶、CRP水平低于对照组(P<0.05)。观察组临床总有效率(86.67%,26/30)高于对照组(63.33%,19/30),P<0.05;观察组患者并发症发生率(13.33%,4/30)低于对照组(36.67%,11/30),P<0.05。结论对急性胰腺炎患者采取经胃镜介导放置空肠营养管肠内营养支持,能有效改善患者营养水平,提高康复质量,降低并发症发生率,提高临床有效率。

Objective To compare the effects of enteral nutrition (EN) by endoscopic jejunal feeding tube placement and total parenteral nutrition (TPN) on patients with acute pancreatitis.Methods A total of 60 patient with acute pancreatitis treated in Central Theater Air Force Hospital from March 2012 to December 2019 were enrolled, and they were divided into control group and observation group by random number table method, with 30 cases in each group. Control group received the TPN, while the observation group received the EN by endoscopic jejunal feeding tube placement. Then, the nutrition level, including serum albumin (ALB), prealbumin (PA), rehabilitation quality (ApacheⅡ), blood amylase level, C-reactive protein (CRP), clinical efficacy and complications were compared between the two groups.Results The ALB and PA levels of the observation group were higher than those of the control group on 14 d after treatment (P<0.05). The Apache Ⅱ scores of the observation group were lower than those of the control group on 7 and 14 d after treatment (P<0.05). The blood amylase level and CRP in the observation group was lower than that in the control group on 14 d after treatment (P<0.05). The total clinical efficacy rate of the observation group was 86.67% (26/30), higher than the 63.33% (19/30) of the control group (P<0.05). The incidence of the complications in the observation group was 13.33% (4/30), lower than the 36.67% (11/30) in the control group (P<0.05).Conclusions EN by endoscopic jejunal feeding tube placement can effectively ameliorate the nutritional level, improve quality of rehabilitation, reduce incidence of complications of patients with acute pancreatitis.