益生菌强化肠内营养支持对重症急性胰腺炎患者胃肠道功能和炎症因子的影响

Effects of Probiotics Enhanced Enteral Nutrition on Gastrointestinal Function and Cytokines in Patients with Severe Acute Pancreatitis

目的探索益生菌联合肠内营养支持的疗法,对重症急性胰腺炎患者的胃肠道功能和炎性因子水平的影响。方法收集昆明市第三人民医院2017年8月至2020年8月期间收治的重症急性胰腺炎患者205例,根据数字随机表法分为102例观察组和103例对照组。对照组在常规治疗的基础上,给予肠内营养支持治疗,观察组在对照组的基础上,联合使用益生菌强化治疗,2组治疗疗程均为1个月。观察2组患者治疗前后的格拉斯哥(GCS)评分变化,免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM),血清D-乳酸、降钙素原(PCT)、内毒素,前白蛋白(PA)、白蛋白(ALB)、转铁蛋白(TF),肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-35(IL-35)的变化,以及发生脓毒血症、多器官功能障碍综合征(MODS)和急性呼吸窘迫综合征(ARDS)的概率。结果经过强化治疗后,观察组的GCS评分均高于对照组;观察组的IgA、IgG、IgM水平均高于对照组;观察组的血清D-乳酸、PCT、内毒素水平均低于对照组;观察组的前白蛋白(PA)、白蛋白(ALB)、转铁蛋白(TF)水平均高于对照组,观察组的血清TNF-α、IL-6水平均低于对照组,血清IL-35水平高于对照组;观察组的脓毒血症发生率、MODS发生率、ARDS发生率均低于对照组;以上差异均具有统计学意义(P<0.05)。结论益生菌联合肠内营养支持的疗法,可以改善重症急性胰腺炎患者的胃肠道功能、免疫功能以及控制机体的炎症反应,并能降低脓毒血症、MODS和ARDS的发生率,值得临床应用推广。

Objective To explore the effect of probiotics combined with enteral nutrition on gastrointestinal function and inflammatory factors in patients with severe acute pancreatitis.Methods The 205 patients with severe acute pancreatitis admitted to Kunming Third People’s Hospital from August 2017 to August 2020 were collected and divided into 102 observation group and 103 control group according to the digital random table method.The control group was given enteral nutrition support on the basis of routine treatment.The control group on the basis of conventional therapy,enteral nutrition therapy,the observation group in the control group based on the combined use of probiotics intensive treatment,after treatment with a course of a month.Observe the changes in the Glasgow(GCS)scores of the two groups of patients before and after treatment,immunoglobulin A(IgA),immunoglobulin G(IgG),immunoglobulin M(IgM),serum D-lactic acid,procalcitonin(PCT),Endotoxin,prealbumin(PA),albumin(ALB),transferrin(TF),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-35(IL-35)changes,and the probability of sepsis,multiple organ dysfunction syndrome(MODS)and acute respiratory distress syndrome(ARDS).Results After intensive treatment,the GCS scores of the observation group were higher than those of the control group;the levels of IgA,IgG,and IgM of the observation group were higher than those of the control group;The serum D-lactic acid,PCT,and endotoxin levels of the observation group were lower than those of the control group;the prealbumin(PA),albumin(ALB)and transferrin(TF)levels of the observation group were higher than those of the control group;Serum TNF-αand IL-6 levels were lower than those of the control group,and serum IL-35 levels were higher than those of the control group;the incidence of sepsis,MODS,and ARDS in the observation group were lower than those of the control group;the above differences All were statistically significant(P<0.05).Conclusion Probiotics can enhance enteral nutrition support,improve gastrointestinal function,immune function and inflammatory response in patients with severe acute pancreatitis,and reduce the incidence of sepsis,MODS and ARDS,which is worth clinical promotion.