谷氨酰胺联合早期肠内营养对急性重症胰腺炎全身炎症的影响  

Effects of glutamine combined with early enteral nutrition on severe acute pancreatitis' systemic inflammation

作　　者：杨国祥 张万里[2] 杜寒松[2] 翟荣林[2] 邱丽[3] 

机构地区：[1]武汉长江航运总医院普外科,湖北武汉430010 [2]武汉协和医院普外科,湖北武汉430022 [3]襄阳市中心医院消化内科,湖北襄阳441021

出　　处：《中国生化药物杂志》2014年第2期125-127,共3页Chinese Journal of Biochemical Pharmaceutics

摘　　要：目的研究谷氨酰胺联合早期肠内营养对急性重症胰腺炎全身炎症的影响。方法根据治疗方法将150例急性重症胰腺炎患者随机分为全肠外营养组(total parenteral nutrition group,TPN组)、早期肠内营养组(early enteral nutrition group,EEN组,n=50)和谷氨酰胺联合早期肠内营养组(Glutamine and early enteral nutrition group,G+EEN组,n=50)。比较各组治疗后疗效、APACHEⅡ评分和肝肾功能的差异,对比治疗前后血清hs-CRP、TNF-α、IL-1β、IL-6、IL-8和IL-10差异。结果 TPN组、EEN组和G+EEN组患者住院时间、死亡率、感染率和手术率依次显著降低(P<0.05),有效率依次显著升高(P<0.05)。TPN组、EEN组和G+EEN组患者治疗后的APACHEⅡ评分、TBIL、ALT和AST依次降低(P<0.05)。3组患者治疗后hs-CRP、TNF-α、IL-1β、II-6和IL-8均显著低于治疗前(P<0.05),IL-10均显著高于治疗前(P<0.05);治疗后TPN组、EEN组和G+EEN组患者的hs-CRP、TNF-α、IL-1β、II-6和IL-8均依次降低(P<0.05),IL-10依次升高(P<0.05)。结论谷氨酰胺联合早期肠内营养可显著改善急性重症胰腺炎患者全身炎症状态,其疗效显著高于单纯早期肠内营养和全肠外营养。Objective To study the glutamine combined with early enteral nutrition’s effects on severe acute pancreatitis’systemic inlfammation. Methods 150 Cases with severe acute pancreatitis were divided into total parenteral nutrtion group(TPN group), early enteral nutrition group(EEN group) and Glutamine and early enteral nutrition group(G+EEN group) according to their therapeutic methods. The curative effects, APACHEⅡscore and liver and kidney function were compared after treatment. Inlfammatory cytokines of hs-CRP, TNF-α, IL-1β, IL-6, IL-8 and IL-10 before and after treatment were detected and compared. Results The efifciency rate in G+EEN group was signiifcantly better than that in TPN and EEN group(P<0.05), with lower APACHEⅡscore and better liver and kidney function. The level of hs-CRP, TNF-α, IL-1β, II-6 and IL-8 after treatment in G+EEN group were signiifcantly lower than that in TPN and EEN group(P<0.05), except IL-10, which was signiifcantly higher than that in TPN and EEN group (P<0.05). Conclusion Glutamine combined with early enteral nutrition could signiifcantly ameliorate severe acute pancreatitis’systemic inlfammation, its curative effects is better than early enteral nutrition and total parenteral nutrition.

关 键 词：急性重症胰腺炎 早期肠内营养 谷氨酰胺 全身炎症 

分 类 号：R657.5[医药卫生—外科学]