不同营养支持方式改善胰腺炎不耐受经口进食患者营养水平的疗效分析

Efficacy of different nutritional therapentic methods on nutritional improvement for pancreatitis patients intolerant to oral feeding

目的比较经鼻胃管、经鼻空肠管以及经肠外营养支持在胰腺炎不耐受经口进食患者中应用的有效性和安全性。方法回顾性分析2018年10月至2020年9月首都医科大学宣武医院普通外科重症监护病房收治的100例不能耐受经口进食的胰腺炎患者的临床资料,其中男性68例,女性32例,年龄(57.4±15.9)岁。依据营养支持方式分为3组:鼻肠管组(n=34)、鼻胃管组(n=33)和肠外营养组(n=33)。记录并比较3组患者的急性生理和慢性健康状况评分Ⅱ(APACHEⅡ)、营养风险筛查2002评分(NRS2002)、血红蛋白、白蛋白、前白蛋白等临床资料。结果与治疗前比较,3组患者治疗后的APACHEⅡ、血红蛋白、白蛋白、前白蛋白均得到改善,差异具有统计学意义(P<0.05)。与治疗前比较,鼻肠管组(Z=2.28)和鼻胃管组(Z=1.99)治疗后的NRS2002均降低,差异具有统计学意义(P<0.05)。与肠外营养组相比,鼻肠管组与鼻胃管组治疗后的NRS2002、白蛋白和前白蛋白水平均改善,鼻肠管组治疗后的APACHEⅡ(t=2.18)和血红蛋白水平(t=2.04)也得到改善,差异有统计学意义(P<0.05)。鼻肠管组并发症发生率低于鼻胃管组[41.2%(14/34)比78.8%(26/33),χ2=5.41]和肠外营养组[41.2%(14/34)比66.7%(22/33),χ2=4.35],差异均具有统计学意义(P<0.05)。结论胰腺炎不耐受经口进食患者采用经鼻胃管和经鼻空肠管肠内营养支持优于肠外营养支持治疗,安全有效。

Objective To compare the efficacy and safety of providing nasogastric(NG),nasojejunal(NJ),and parenteral nutrition(PN)support to pancreatitis patients who were intolerant to oral feeding.Methods One hundred pancreatitis patients who were intolerant to oral feeding treated at the Xuanwu Hospital of the Capital Medical University from October 2018 to September 2020 were retrospectively studied.They were divided into three groups based on the nutritional support given to them:the NG group,NJ group,and PN group.The acute physiology and chronic health evaluationⅡ(APACHEⅡ),nutritional risk screening 2002(NRS2002),hemoglobin,albumin,pre-albumin and other clinical data were recorded and compared among the three groups.Results After nutrition support treatments,the hemoglobin,albumin and pre-albumin levels were significantly better than before giving nutrition support,and the APACHEⅡscores were significantly improved in all the groups.The NRS2002 scores were significantly better in the NJ group(Z=2.28,P=0.023)and the NG group(Z=1.99,P=0.046).With compared to the PN group,the albumin and pre-albumin levels were significantly higher in the NG and NJ groups,and the NRS2002 score after giving nutrition support treatment was significantly lower(P<0.05).Compared with the PN group,the APACHEⅡscore(t=2.18)and the hemoglobin levels(t=2.04)were significantly better in the NJ group(P<0.05).The overall incidence of complications in the NJ group was 41.2%(14/34),which was significantly lower than the NG group[78.8%(26/33),χ2=5.41,P=0.020]and the PN group[66.7%(22/33),χ2=4.35,P=0.037].Conclusion Enteral nutrition support through NG and NJ are better than PN in acute pancreatitis patients who were intolerant to oral feeding.