早期不同肠内营养方式对重症急性胰腺炎患者炎性因子及预后的影响

Effect of early enteral nutrition on inflammatory factors and prognosis in patients with severe acute pancreatitis

目的探讨早期不同肠内营养(EN)喂养方式对重症急性胰腺炎(severe acute pancreatitis,SAP)患者炎性因子及预后的影响。方法选取2015年7月—2018年7月徐州医科大学附属医院急诊重症医学科收治的SAP患者90例,采用随机数字表法分为对照组(45例)和观察组(45例)。对照组患者给予鼻胃管肠内营养,观察组患者给予鼻空肠管肠内营养。比较两组营养支持前后实验室指标[血淀粉酶(AM)、C反应蛋白(CRP)、白细胞计数(WBC)、清蛋白(ALB)、甘油三酯(TG)及空腹血糖(FBG)水平]、T细胞亚群及细胞因子水平,以及并发症发生情况。结果观察组住院时间及ICU入住时间均显著低于对照组,差异具有统计学意义(P<0.05)。观察组死亡例数低于对照组,但差异无统计学意义(P>0.05)。治疗前及治疗1周后两组AM、CRP、WBC、ALB、TG及FBG水平比较差异无统计学意义(P>0.05)。治疗1周后观察组CD3+、CD4+及CD4+/CD8+值均显著高于对照组,CD8+显著低于对照组,观察组TNF-α、IL-6、ET及D-LA均显著低于对照组,差异具有统计学意义(P<0.05)。观察组营养支持期间并发症总发生率低于对照组,差异具有统计学意义(P<0.05)。结论早期经鼻空肠EN与经鼻胃EN治疗对SAP患者血清AM、CRP、WBC、ALB、TG及FBG水平改善效果相当,但经鼻空肠EN降低SAP患者炎症反应、降低血清D-LA水平进而改善肠道屏障功能、提高免疫功能及减少并发症的优势更显著。

Objective To study the effect of early enteral nutrition on inflammatory factors and prognosis in patients with severe acute pancreatitis(SAP).Methods From July 2015 to July 2018,90 patients with SAP were selected.They were divided into control groups(45 cases)and observation group(45 cases).The patients in the control group were given the enteral nutrition of the nasogastric tube,and the patients in the observation group were given the enteral nutrition of the nasojejunal tube.The laboratory indexes(AM、CRP、WBC、ALB、TG and FBG),T lymphocyte subsets and cytokines before and after nutritional support were compared between the two groups,and the occurrence of complications during nutritional support was compared between the two groups.Results The hospitalization time and ICU stay time in the observation group were significantly lower than those in the control group(P<0.05).The number of deaths in the observation group was lower than that in the control group,but there was no significant difference(P>0.05).There was no significant difference in the levels of AM,CRP,WBC,ALB,TG and FBG between the two groups before and 1 week after treatment(P>0.05).The values of CD3+,CD4+and CD4+/CD8+in the observation group after 1 week treatment were significantly higher than those in the control group,while CD8+was significantly lower than that in the control group.The level of TNF-αhe leve ET and D-LA in the observation group were significantly lower than those in the control group(P<0.05).The total incidence of complications during nutritional support in the observation group was lower than that in the control group,the difference was statistically significant(P<0.05).Conclusion Early transnasojejunal EN and transnasogastric EN can improve the level of serum AM,CRP,WBC,ALB,TG and FBG of SAP patients.However,transnasojejunal EN can decrease inflammatory reaction,decrease serum D-LA level,improve intestinal barrier function,improve immune function and reduce complications in patients with SAP.