个性化肠内营养在治疗重症急性胰腺炎中的应用

Role of personalized enteral nutrition in the treatment of severe acute pancreatitis

目的：探讨针对个体病情与代谢特点提供的肠内营养支持治疗对重症急性胰腺炎的临床治疗效果。方法将2013年6月1日至2014年3月31日广州军区武汉总医院消化内科收治的重症急性胰腺炎患者24例，按照随机数字表法分为实验组和对照组各12例，对照组按照基础能量供给公式计算能量供给量，实验组按照实际能量供给公式计算能量供给量。比较2组患者的血红蛋白、白蛋白、C-反应蛋白、血淀粉酶、尿淀粉酶、住院时间及住院费用的变化情况。结果营养支持第7天，实验组血红蛋白、白蛋白含量显著高于对照组[（130.50±17.60）g/L比（126.33±23.96）g/L，t=-4.231，P<0.05；（40.88±4.66）g/L比（36.29±3.45）g/L，t=-2.263，P<0.05]，差异有统计学意义。实验组C-反应蛋白在营养支持第7天显著低于对照组[（47.62±9.89）mg/L比（58.22±11.23）mg/L，t=3.618，P<0.05]，差异有统计学意义。对照组与实验组患者住院时间、住院费用比较[（22.50±5.85）d比（16.75±6.47）d，t=12.272， P<0.01；（36364.76±2162.08）元比（14143.44±3921.78）元，t=9.421，P<0.01]，差异有统计学意义。结论实施个性化的肠内营养更符合患者的个体生理需求，不影响胰腺的分泌，避免对消化道造成损伤；同时可减少炎性介质的生成，利于疾病恢复，从而大大减少了患者及社会的经济负担。

Objective To observe the outcome of the implementation of personalized enteral nutrition of severe acute pancreatitis patients. Methods 24 patients with severe acute pancreatitis admitted from June 1, 2013 to March 31, 2014 were divided into experimental group and control group according to the random number table method. Control group calculated the energy supply according to the basic energy expend formula while experimental group according to the actual enery expend formula. Hemoglobin, albumin, C-reactive protein, serum and urine amylase, complication rate, hospitalization time and cost changes were compared. Results 7 days after enteral nutrition, hemoglobin content and albumin content of experimental group were higher than those of control group ((130.50±17.60) g/L vs.(126.33±23.96) g/L, t=-4.231, P<0.05; (40.88±4.66) g/L vs.(36.29±3.45) g/L, t=-2.263, P<0.05)And C-reactive protein of experimental group were lower than that of control group ((47.62±9.89) mg/L vs.(58.22±11.23) mg/L, t=3.618, P<0.05)Hospitalization time and cost of experimental group were lower than those of control group ((22.50±5.85) d vs.(16.75±6.47) d, t=12.272, P<0.01; (36 364.76±2 162.08) yuan vs.(14 143.44±3 921.78) yuan, t=9.421, P<0.01)Conclusions The implementation of personalized enteral nutrition is more hepful for the physiological requirements of individual patients, and not affect the pancreatic secretion. At the same time, inflammatory mediators can be reduced and also reduce the economic burden of patients and society.