免疫增强型肠内营养方案联合微创腹腔引流在重症急性胰腺炎中的临床应用

Clinical application of immune-enhancing enteral nutrition combined with minimally invasive abdominal drainage in severe acute pancreatitis

目的探讨免疫增强型肠内营养方案联合微创腹腔引流应用于重症急性胰腺炎(severe acute pancreatitis,SAP)的临床效果。方法回顾性分析SAP患者136例的临床资料,均常规采取微创腹腔引流等综合性治疗措施。根据肠内营养方式不同分为对照组62例(给予普通肠内营养治疗)和联合组74例(给予免疫增强型肠内营养方案)。于治疗前和治疗7 d后比较2组血清营养指标[白蛋白(albumin,Alb)、前白蛋白(prealbumin,PA)、转铁蛋白(transferrin,Tf)]、血清体液免疫指标[免疫球蛋白(immunoglobulin,Ig)A、IgG、IgM]变化,比较2组7 d、30 d病死率及基本康复指标差异。结果2组7 d病死率差异无统计学意义(P>0.05)。联合组30 d病死率明显低于对照组(P<0.05)。治疗7 d后,2组血清Alb、PA、Tf、IgA、IgG、IgM水平均明显高于治疗前,联合组血清Alb、PA、Tf、IgA、IgG、IgM水平明显高于对照组(P<0.05)。联合组恢复进食时间、引流时间、住重症监护病房时间及住院时间均明显短于对照组(P<0.05)。结论免疫增强型肠内营养方案联合微创腹腔引流治疗SAP效果显著,有利于提高存活率,加快身体恢复。

Objective To explore the clinical effects of immune-enhancing enteral nutrition combined with minimally invasive abdominal drainage on patients with severe acute pancreatitis(SAP).Methods The clinical data of 136 patients with SAP were retrospectively analyzed.The patients were given routine comprehensive treatment measures including minimally invasive abdominal drainage.The patients were divided into control group(n=62,given ordinary enteral nutrition therapy)and combined group(n=74,given immune-enhancing enteral nutrition regimen)according to different enteral nutrition methods.The serum nutritional indicators[albumin(Alb),prealbumin(PA),transferrin(Tf)]and serum humoral immune indexes[immunoglobulin(Ig)A,IgG,IgM]were compared between two groups before treatment and after 7 d of treatment.The 7 d and 30 d mortality rates and basic rehabilitation indicators were compared between two groups.Results There was no significant differences in the 7 d mortality rate between two groups(P>0.05).The 30 d mortality rate in combined group was significantly lower than those in control group(P<0.05).After 7 d of treatment,the levels of serum Alb,PA,Tf,IgA,IgG and IgM in two groups were significantly higher than those before treatment,and the levels of serum Alb,PA,Tf,IgA,IgG and IgM in combined group were significantly higher than those in control group(P<0.05).The feeding recovery time,drainage time,intensive care unit(ICU)stay and hospital stay in combined group were significantly shorter than those in control group(P<0.05).Conclusion Immune-enhancing enteral nutrition combined with minimally invasive abdominal drainage has prominent effects in the treatment of SAP,and it is beneficial to improve the survival rate and accelerate the recovery of body.