可溶性膳食纤维对儿童急性胰腺炎胃肠功能的影响

Effect of Soluble Dietary Fiber on Gastrointestinal Function in Children with Acute Pancreatitis

目的探讨可溶性膳食纤维(SDF)对儿童急性胰腺炎胃肠功能耐受、黏膜屏障及临床疗效的影响。方法回顾性分析新乡医学院附属郑州儿童医院2018年1月-2020年12月收治的38例急性胰腺炎患儿,根据治疗方式分为对照组(17例)和治疗组(21例),对照组接受单纯早期肠内营养(EEN)治疗,治疗组接受添加SDF的EEN治疗。两组均于24 h内胃镜引导下置入鼻肠管至Treitz韧带远端,连续泵入糖盐水、小百肽等热卡营养物质,治疗组于开始EEN时添加SDF溶于肠内营养液;比较两组临床特征、胃肠功能耐受、肠道黏膜屏障及住院时间。结果治疗组达到目标热量时间短于对照组,腹胀、腹泻和便秘喂养不耐受症状发生率少于对照组,差异有统计学意义(P<0.05);治疗组第14天肠鸣音次数多于对照组,第一次排气、排便时间短于对照组,差异有统计学意义(P<0.05);治疗组脂肪酶、血淀粉酶低于对照组,肠粘膜屏障功能相关指标优于对照组,差异有统计学意义(P<0.05);治疗组TNF-α、IL-6低于对照组,差异有统计学意义(P<0.05);治疗组第14天APACHEⅡ评分、BISAP评分均低于对照组,ICU住院天数、总住院天数短于对照组,差异有统计学意义(P<0.05)。结论EEN添加SDF可缩短EN期间达到能量目标时间,改善肠道功能,减少炎症反应,降低胰腺炎患儿摄食不耐受的发生率。

Objective To investigate the effect of soluble dietary fiber(SDF)on gastrointestinal function tolerance,mucosal barrier and clinical efficacy in children with acute pancreatitis.Methods A retrospective analysis was performed on 38 children with acute pancreatitis admitted to Zhengzhou Children's Hospital Affiliated to Xinxiang Medical University from January 2018 to December 2020.According to the treatment methods,they were divided into control group(17 cases)and treatment group(21 cases).The control group received simple early enteral nutrition(EEN)treatment,and the treatment group received SDF-added EEN treatment.In both groups,the nasointestinal tube was inserted into the distal end of Treitz ligament under the guidance of gastroscope within 24 hours,and the calorie nutrients such as sugar saline and small peptide were continuously pumped.In the treatment group,SDF was added to the enteral nutrient solution at the beginning of EEN.The clinical characteristics,gastrointestinal function tolerance,intestinal mucosal barrier and hospitalization time were compared between the two groups.Results The time of reaching the target calorie in the treatment group was shorter than that in the control group,and the incidence of abdominal distension,diarrhea and constipation feeding intolerance in the treatment group was lower than that in the control group,the difference was statistically significant(P<0.05).The number of bowel sounds in the treatment group on the 14th day was more than that in the control group,and the first exhaust and defecation time was shorter than that in the control group,the difference was statistically significant(P<0.05).The lipase and blood amylase in the treatment group were lower than those in the control group,and the related indexes of intestinal mucosal barrier function were better than those in the control group,the difference was statistically significant(P<0.05).The levels of TNF-αand IL-6 in the treatment group were lower than those in the control group,the difference was statistically significant(P<0.05).The APACHEⅡscore and BISAP score of the treatment group on the 14th day were lower than those of the control group,and the ICU hospitalization days and total hospitalization days were shorter than those of the control group,the difference was statistically significant(P<0.05).Conclusion EEN supplemented with SDF can shorten the time to reach the energy target during EN,improve intestinal function,reduce inflammation,and reduce the incidence of feeding intolerance in children with pancreatitis.