肠内营养支持联合益生菌对重症急性胰腺炎合并慢重症患者肠道功能和预后的影响

Effect of enteral nutrition support combined with probiotics on intestinal function and prognosis in patients with severe acute pancreatitis complicated with chronically critical ill

目的分析肠内营养支持联合益生菌对重症急性胰腺炎(severe acute pancreatitis,SAP)合并慢重症(chronically critical ill,CCI)患者肠道功能和预后的影响。方法选取2018年4月至2021年4月首都医科大学附属北京友谊医院收治的64例SAP合并CCI患者为研究对象,使用随机数字表法将入选患者分别纳入联合组和对照组,每组各32例。两组患者均予常规综合治疗,并给予早期肠内营养支持,联合组患者加用益生菌治疗,持续14 d。对比两组患者治疗前后血清炎性因子、白蛋白、淀粉酶、肠黏膜屏障指标及胃肠功能评分、脱机率、并发症发生率、感染率、病死率、住院天数。结果两组患者治疗后血清C反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白介素-6(interleukin-6,IL-6)、内毒素、二胺氧化酶(diamine oxidase,DAO)、淀粉酶水平和胃肠功能评分均显著低于本组治疗前(均P<0.05),血清白蛋白水平均显著高于本组治疗前(均P<0.05)。联合组患者治疗后血清CRP、TNF-α、IL-6、内毒素、DAO、淀粉酶水平和胃肠功能评分均显著低于对照组(均P<0.05),血清白蛋白水平显著高于对照组(P<0.05)。联合组患者脱机率显著高于对照组(P<0.05),并发症发生率、感染率、病死率均显著低于对照组(均P<0.05),住院天数显著短于对照组(P<0.05)。结论在综合治疗和肠内营养支持的基础上,联合益生菌有助于减轻SAP合并CCI患者机体炎症反应,改善营养状况,提高肠黏膜屏障功能,促进胃肠功能恢复,从而提高脱机率、降低病死率,达到改善患者预后的目的。

Objective To analyze the effect of enteral nutrition(EN)support combined with probiotics on intestinal function and prognosis of patients with severe acute pancreatitis(SAP)complicated with chronically critical ill(CCI).Method A total of 64 patients with SAP complicated with CCI who were admitted to Beijing Friendship Hospital,Capital Medical University from April 2018 to April 2021 were included in the study.They were divided into combination group and control group using random number table method,with 32 cases in each group.The two groups were given conventional comprehensive treatment and early EN support,while combination group was additionally given probiotic therapy,which lasted for 14 days.The changes of serum inflammatory factors,albumin,amylase,intestinal mucosal barrier indexes and gastrointestinal function score before and after treatment,the offline rate,complication rate,infection rate,mortality rate and hospital day of the two groups were compared.Result After treatment,the serum C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),endotoxin,diamine oxidase(DAO),amylase levels and gastrointestinal function scores of patients in the two groups were significantly lower than those before treatment in the same group(all P<0.05),the serum albumin levels were significantly higher than those before treatment in the same group(all P<0.05).The levels of serum CRP,TNF-α,IL-6,endotoxin,DAO,amylase and gastrointestinal function scores of patients in combination group after treatment were significantly lower than those in control group(all P<0.05),and the serum albumin level was significantly higher than that in control group(P<0.05).The offline rate of patients in combination group was significantly higher than that in control group(P<0.05),the complication incidence,infection rate and mortality were significantly lower than those in control group(all P<0.05),the hospital day was significantly shorter than that in control group(P<0.05).Conclusion On the basis of comprehensive treatment and EN support,the combination of probiotics helps to reduce the inflammatory response in patients with SAP complicated with CCI,improve nutritional status and intestinal mucosal barrier function,and promote the recovery of gastrointestinal function,thereby increasing the offline rate and reducing the mortality,to achieve the purpose of improving the prognosis of patients.