早期肠内营养联合微生态制剂对重症急性胰腺炎患者的临床疗效及其对免疫功能的影响

The effect of early enteral nutrition combined with microecological preparations on the clinical efficacy and immune function of patients with severe acute pancreatitis

目的 分析早期肠内营养联合微生态制剂对重症急性胰腺炎患者的临床疗效及其免疫功能的影响。方法 选择我院2017年6月至2020年1月间收治的80例符合标准的重症急性胰腺炎患者为研究对象并随机分为观察组和对照组,每组40例。对照组患者给予早期肠内营养干预。观察组患者采用早期肠内营养加微生态制剂治疗。评估患者疗效,同时评估治疗前、治疗7 d及治疗14 d时患者腹内压、胃肠功能、免疫球蛋白、炎症因子、淀粉酶、血清脂肪酶、血清乳酸脱氢酶及T细胞亚群水平。结果 观察组患者临床总有效率高于对照组(97.50%vs 80.00%,P<0.05)。治疗7 d和治疗14 d时,观察组患者腹内压水平、胃肠功能评分显著低于对照组(均P<0.05)。治疗7 d和治疗14 d时,观察组患者血清IgG、IgM及IgA水平显著高于对照组,而IL-6、TNF-α、CRP、淀粉酶、脂肪酶及乳酸脱氢酶水平显著低于对照组(均P<0.05)。治疗7 d和治疗14 d时,观察组患者血液中CD3^(+)、CD4^(+)水平和CD4^(+)/CD8^(+)比值显著高于对照组,而CD8^(+)水平低于对照组(均P<0.05)。结论 早期肠内营养联合微生态制剂可显著提高重症急性胰腺炎患者的临床疗效,并改善患者免疫功能。

Objective To analyze the effect of early enteral nutrition combined with probiotics on the clinical efficacy and immune function of severe acute pancreatitis(SAP) patients. Methods Eighty patients with SAP who were admitted to our hospital from June 2017 to January 2020 were randomly divided into observation group or control group, 40 cases in each group. The control group was given early enteral nutrition intervention;the observation group was given early enteral nutrition combined with microecological preparation. The clinical efficacy was evaluated. Before treatment, after 7 days of treatment and 14 days of treatment, the patient′s intra-abdominal pressure, gastrointestinal function, immunoglobulin, inflammatory factors, amylase, serum lipase, and levels of serum lactic acid depletion hydrogenase and T cell subpopulation were evaluated. Results The clinical efficacy in the observation group was significantly higher than in the control group(97.50% vs 80.00%, P<0.05). After 7 days and 14 days of treatment, the intra-abdominal pressure and gastrointestinal function score of the patients in the observation group were significantly lower than in the control group respectively(all P<0.05). After 7 days and 14 days of treatment, the levels of IgG, IgM and IgA in the observation group were significantly higher, while those of IL-6, TNF-α, CRP, amylase, lipase and lactate dehydrogenase were significantly lower than in the control group, respectively(all P<0.05). At 7 and 14 days of treatment, the levels of CD3^(+),CD4^(+) and CD4^(+)/CD8^(+) in the blood of the observation group were significantly higher than those of the control group, while the level of CD8^(+) was lower than that of the control group(all P<0.05). Conclusion Early enteral nutrition plus microecological preparations can significantly improve the clinical efficacy and improve the immune function of patients with severe acute pancreatitis.