重症急性胰腺炎术后早期经胃造瘘管套入的空肠营养管行肠内营养效果观察  

Effect of early EN through jejunal nutrient canal cannulated by gastrostomy canal after operation for SAP

作　　者：李燕[1] 俞景奎[1] 

机构地区：[1]滕州市中心人民医院,山东滕州277500

出　　处：《山东医药》2005年第17期12-14,共3页Shandong Medical Journal

基　　金：枣庄市科技局科技发展计划项目(No.2004-639)

摘　　要：目的探讨在重症急性胰腺炎(SAP)术后早期经胃造瘘管套入的空肠营养管行肠内营养的效果。方法将需手术治疗的60例SAP患者随机分成对照组及研究组各30例,对照组采用传统手术肠内营养方法,研究组对传统治疗方法进行改进,将空肠造瘘管改为经胃造瘘管套入一空肠营养管入空肠,其头端距幽门约100cm以上。术后4～6天待肠功能恢复后,经空肠营养管持续滴入肠内营养乳剂—瑞高。结果术后14天研究组IgA、CD4、CD4/CD8高于对照组(P均<0.05),CD8低于对照组(P<0.05);IL-6、TNF-α低于对照组(P均<0.01);血、尿淀粉酶低于对照组(P均<0.05);病死率低于对照组(P<0.05);住院时间短于对照组(P<0.01)。结论SAP术后经胃造瘘管套入的空肠营养管早期滴注瑞高不仅能提供营养,还可改善肠黏膜屏障功能,减少肠细菌移位,提高免疫功能;可降低病死率,缩短住院时间;不需行空肠造瘘,可减少手术步骤及时间,减少术后肠粘连的机会。Objective To study curative effect of early Enteral nutrition emulsion (ENE) through jejunal nutrient canal cannulated by gastrostomy canal after operation for severe acute pancreatitis.Methods 60 patients with severe acute pancreatitis who needed operation were divided randomly into two groups,control group included 30 cases for whom traditional general therapy and operation were applied,study group was composed of 30 cases for whom traditional therapy was modified.Jejunal fistula was replaced by jejunal nutrient canal cannulated by gastrostomy canal into jejun.The head end was over 100 cm away from pylorus.4~6 days after operation,ENE was given by constent drip through jejunal nutrient canal after jejunal function recovered.Results 14 days after operation,IgA,CD4 and CD4/CD8 in study group were higher than those in control group and there were significant difference (P<0.05).CD8 in study group was lower than that in control group (P<0.05).IL-6 and TNF-α in study group were lower than those in control group (P<0.01).Blood amylase and urine amylase in study group were lower than those in control group (P<0.05).Death rate in study group was lower than that in control group (P<0.05).Hospitalization time of study group was shorter than that of control group (P<0.01).Conclusions ENE early drip through jejunal nutrient canal cannulated by gastrostomy canal after operation for severe acute pancreatitis could supply nutrient and improve barrier function of jejunal membrane and reduce enterobacteria traslocation and improve immunal function thus to reduce death rate and shorten hospitalization time;Jejunal fistula is not necessary,so operation steps and time can be reduced and postoperative intestinal adhesion decreased.It is very valuable in clinical application.

关 键 词：重症急性胰腺炎 空肠营养管 术后早期 效果观察 管套 CD4/CD8 肠内营养方法 传统治疗方法 对照组 住院时间 空肠造瘘管 肠功能恢复 肠细菌移位 术后肠粘连 手术治疗 传统手术 胃造瘘管 IL-6 尿淀粉酶 屏障功能 免疫功能 

分 类 号：R657.51[医药卫生—外科学] R459.3[医药卫生—临床医学]