重症急性胰腺炎及腹腔感染所致腹腔开放病人的营养支持

Nutritional support for patients with open abdomen due to severe acute pancreatitis and abdominal infection

目的探讨不同营养支持方式在重症急性胰腺炎及腹腔感染所致的腹腔开放(open abdomen,OA)病人中的应用和对病人预后的影响。方法回顾性纳入自2016年1月至2020年12月上海交通大学医学院附属第九人民医院普外科重症监护室所收治的因重症急性胰腺炎和腹腔感染行OA治疗的病人25例。回顾病人病程中的营养支持方式并将病人分为单纯肠内营养组(enteral nutrition,EN,8例)及EN联合全肠外营养(total parenteral nutrition,EN+TPN,17例),比较两组病人一般临床资料、热卡达标率、胃肠道功能障碍及临床预后的差异。结果两组病人年龄、性别、原发病、合并症、疾病危重度、静息能量消耗、感染指标、肝肾功能、凝血功能等差异均无统计学意义(均P>0.05)。热卡达标率比较,EN组早期热卡达标率显著低于EN+TPN组(营养支持第5、7、11天比较,均P<0.05),平均达标时间显著长于EN+TPN组(P=0.005)。胃肠道功能障碍比较中,EN+TPN组消化道麻痹发生率显著高于EN组(37.5%比82.4%,P=0.024)。临床预后比较,两组死亡率差异无统计学意义(P>0.05),EN组住院总费用显著低于EN+TPN组(P=0.045)。结论OA病人给予单纯EN的营养支持方式是安全可行的,虽然额外添加TPN能早期达到热卡目标,但并未能让病人获益。

Objective To explore the efficacy and impact on clinical outcomes of different nutritional support modes for open abdomen(OA)patients caused by severe acute pancreatitis and abdominal infection.Methods From January 2016 to December 2020,25 patients treated with OA due to severe acute pancreatitis and abdominal infection in Intensive Care Unit were retrospectively reviewed.They were divided into two groups of enteral nutrition(EN,n=8)and EN plus total parenteral nutrition(EN+TPN,n=17).Inter-group differences in general profiles,target calorie compliance rate,gastrointestinal dysfunction and clinical prognosis were compared.Results No inter-group statistical differences existed in age,gender,primary disease,comorbidities,disease severity,resting energy expenditure(REE),infection index,liver and kidney function or coagulation function(all P>0.05).As for target calorie compliance rate,EN group was significantly lower in early phase(all P<0.05 at day 5,7 and 11 days of nutritional support)and the average time of attaining target was significantly longer than that in EN+TPN group(P=0.005).As for gastrointestinal dysfunction,EN+TPN group showed a significantly higher incidence of gastrointestinal paralysis than that in EN group(37.5%vs.82.4%,P=0.024).As for clinical outcomes,no inter-group statistical difference existed in mortality(P>0.05).EN group showed significantly lower hospitalization expenditure(P=0.045)than that in EN+TPN group.Conclusion EN alone is both safe and feasible for OA patients.Although additional TPN may attain caloriefeeding goals earlier,it does not offer more benefits.