早期肠内营养对重症急性胰腺炎患者营养状态和炎症因子的影响

Effect of early enteral nutrition on nutritional status and inflammatory factors in patients with severe acute pancreatitis

目的探讨早期肠内营养对重症急性胰腺炎(SAP)患者营养状态和炎症因子的影响。方法116例SAP患者,依据随机数字表法分为早期组和延期组,每组58例。早期组给予早期(入院24h内)肠内营养,延期组给予延期(入院48h后)肠内营养。比较两组营养状态[总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)]、炎症因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]、病情转归[腹痛缓解、血和尿淀粉酶(AMS)恢复、住院时间]、并发症发生情况及死亡情况。结果治疗后,两组TP、ALB、PA水平均明显高于本组治疗前,且早期组TP(61.88±6.53)g/L、ALB(27.39±3.02)g/L、PA(95.72±9.93)mg/L明显高于延期组的(54.27±5.87)g/L、(23.06±2.61)g/L、(85.96±8.99)mg/L,差异具有统计学意义(P<0.05)。治疗后,两组IL-6、TNF-α、CRP水平均明显低于本组治疗前,且早期组IL-6(3.42±0.38)ng/L、TNF-α(66.27±6.96)ng/L、CRP(62.47±6.74)mg/L明显低于延期组的(3.81±0.41)ng/L、(75.91±7.89)ng/L、(83.04±8.61)mg/L,差异具有统计学意义(P<0.05)。早期组腹痛缓解时间(4.21±0.53)d、血AMS恢复时间(6.24±0.75)d、尿AMS恢复时间(15.69±1.88)d、住院时间(26.21±3.05)d均明显短于延期组的(5.86±0.64)、(9.73±1.09)、(19.36±2.18)、(32.18±3.71)d,差异具有统计学意义(P<0.05)。早期组并发症发生率17.24%明显低于延期组的34.48%,差异有统计学意义(P<0.05);两组死亡率比较差异无统计学意义(P>0.05)。结论早期肠内营养可有效改善SAP患者营养状态、炎症因子,有利于患者病情转归,且可减少并发症,值得临床推广。

Objective To discuss the effect of early enteral nutrition on nutritional status and inflammatory factors in patients with severe acute pancreatitis(SAP).Methods A total of 116 SAP patients were divided into early group and delayed group according to random numerical table,with 58 patients in each group.The early group was given early(24 h after admission)enteral nutrition,and the delayed group was given delayed(48 h after admission)enteral nutrition.Both groups were compared in terms of nutritional status[total protein(TP),albumin(ALB),prealbumin(PA)],inflammatory factors[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)],prognosis[abdominal pain relief,recovery of blood and urine amylase(AMS),length of hospital stay],incidence of complications and death.Results After treatment,the levels of TP,ALB and PA in the two groups were significantly higher than those before treatment in this group;the levels of TP(61.88±6.53)g/L,ALB(27.39±3.02)g/L and PA(95.72±9.93)mg/L in the early group were significantly higher than(54.27±5.87)g/L,(23.06±2.61)g/L and(85.96±8.99)mg/L in the delayed group;the differences were statistically significant(P<0.05).After treatment,the IL-6 and TNF-α,CRP levels in both groups were significantly lower than those before treatment in this group;the IL-6(3.42±0.38)ng/L,TNF-α(66.27±6.96)ng/L,CRP(62.47±6.74)mg/L in early group were significantly lower than(3.81±0.41)ng/L,(75.91±7.89)ng/L,(83.04±8.61)mg/L in the delayed group;the differences were statistically significant(P<0.05).The abdominal pain relief time(4.21±0.53)d,blood AMS recovery time(6.24±0.75)d,urinary AMS recovery time(15.69±1.88)d and length of hospital stay(26.21±3.05)d in the early group were significantly shorter than(5.86±0.64),(9.73±1.09),(19.36±2.18)and(32.18±3.71)d in the delayed group,and the differences were statistically significant(P<0.05).The incidence of complications in the early group was 17.24%,which was lower than 34.48%in the delayed group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in death rate between the two groups(P>0.05).Conclusion Enteral nutrition can effectively improve the nutritional status and inflammatory factors of SAP patients,which is conducive to the prognosis of patients,and can reduce complications.It is worthy of clinical promotion.