新型便携式肠内营养包在急性胰腺炎患者家庭肠内营养中的应用效果

Therapeutic effects of a novel portable enteral nutrition kit on enteral nutrition at home for patients with acute pancreatitis

目的探讨自行设计的一种新型便携式肠内营养包用于急性胰腺炎(AP)患者家庭肠内营养的可行性和应用效果。方法选取2022年4月至2023年6月间海军军医大学第一附属医院消化内科收治的60例出院后仍需要家庭肠内营养的MSAP及SAP患者,按照数字表法随机分为使用新型便携式肠内营养包组(观察组,28例)和常规肠内营养组(对照组,29例)。出院前给予患者相关肠内营养指导,出院后每周进行电话随访,指导患者相关家庭肠内营养问题的解决,拔管后随访终止。记录出院前患者年龄、性别、体重指数、疾病严重程度、相关实验室检查指标(白细胞、血红蛋白、白蛋白、总蛋白)、胰腺炎相关并发症及随访期间体重指数变化、相关实验室检查指标、消化道症状、感染相关并发症、营养管相关并发症及Barthel指数评分等。结果两组患者各项基线指标差异无统计学意义,具有可比性。随访第1、2、3、4周,两组患者感染及营养管相关并发症的发生率差异无统计学意义,但观察组消化道症状发生率显著低于对照组,差异有统计学意义(P<0.05)。随访第3周和第4周,观察组患者的体重指数[(22.38±3.84)kg/m^(2)比(20.38±3.56)kg/m^(2)、(22.59±3.77)kg/m^(2)比(20.54±3.37)kg/m^(2)]、血红蛋白水平[(125.00±13.46)g/L比(113.4±13.64)g/L、(126.20±14.37)g/L比(114.3±13.25)g/L]、白蛋白水平[(40.96±3.07)g/L比(39.17±3.31)g/L、(41.79±2.73)g/L比(39.97±2.67)g/L]及生活能力评分[(87.32±5.85)分比(82.59±9.79)分、(89.64±1.31)分比(83.97±8.80)分]均显著高于对照组,差异均有统计学意义(P值均<0.05)。结论使用新型便携式肠内营养包有助于减少需长期肠内营养的AP患者的消化道症状,提升营养状态,改善生活能力。

Objective To investigate the feasibility and therapeutic effects of a self-designed portable enteral nutrition(EN)kit for home EN in patients with acute pancreatitis(AP).Methods A total of 60 patients suffered from moderately severe AP and severe AP and needed home EN in Department of Gastroenterology of First Affiliated Hospital of Naval Medical University between April 2022 and June 2023 were enrolled.They were randomly assigned to portable EN group(observation group,n=28)and routine EN group(control group,n=29)according to random number table.All patients were given EN guidance before discharge.After discharge,all patients were given weekly telephone follow-up to guide the resolution of home EN problems.Patients were followed up from discharge to extubation.The age,gender,body mass index(BMI),disease severity,laboratory indicators(white blood cell,hemoglobin,albumin,total protein),AP related complications before discharge were recorded.During the follow-up period,changes in BMI,laboratory indicators,gastrointestinal symptoms,infection related complications,nutrition tube related complications and Barthel index were recorded.Results all indicators in the two groups were not significantly statistically different,which comparable at baseline.During the 1-week,2-week,3-week and 4-week follow-up period,there was no significant difference on the incidence of infection and complications related to nutrition tube between the two groups,while the incidence of gastrointestinal symptoms in observation group was significantly lower than that in control group and the difference was statistically significant(P<0.05).At the 3-week and 4-week follow-up,the BMI[(22.38±3.84)vs(20.38±3.56)kg/m^(2);(22.59±3.77)vs(20.54±3.37)kg/m^(2)],hemoglobin[(125.00±13.46)vs(113.4±13.64)g/L;(126.20±14.37)vs(114.3±13.25)g/L],and albumin[(40.96±3.07)vs(39.17±3.31)g/L;(41.79±2.73)vs(39.97±2.67)g/L]levels of the observation group were significantly higher than those of the control group;the living ability score of the observation group was significantly higher than that of the control group(87.32±5.85 vs 82.59±9.79;89.64±1.31 vs 83.97±8.80);and all the differences were statistically significant(all P value<0.05).Conclusions The application of portable EN kit can help reduce the gastrointestinal symptoms of AP patients who need long-term home EN,improve nutritional status and life ability.