生态免疫肠内营养对急性胰腺炎肠道通透性及感染并发症的影响  

Effect of ecoimmunonutrition on gut permeability and sepsis in patients with acute pancreatitis

作　　者：秦环龙[1] 郑嘉佳[1] 佟大年[1] 陈维雄[2] 蒋燕群[3] 范小兵[4] 杭晓敏[4] 

机构地区：[1]上海交通大学附属第六人民医院普通外科,200233 [2]上海交通大学附属第六人民医院消化科 [3]上海交通大学附属第六人民医院检验科 [4]上海交通大学生命技术学院

出　　处：《中华普通外科杂志》2007年第3期206-210,共5页Chinese Journal of General Surgery

基　　金：上海市卫生科技发展基金重点资助项目（200401）

摘　　要：目的 观察生态免疫肠内营养对急性胰腺炎肠通透性及感染并发症的影响。方法76例急性胰腺炎患者在入院48h内随机分为2组，即肠外营养组（PN组）38例和生态免疫肠内营养组（EIN组）36例，EIN组经鼻空肠营养管注入100ml植物乳酸菌（活菌，1×10^8cfu／ml）持续7d。观察入院时和第8天APACHEⅡ、Balthazar CT评分，统计SIRS，MODS发生率，测定鼻胃管抽吸物细菌含量；入院时、支持后第5天和第8天口服乳果糖和甘露醇（L／M），采用HPLC测定尿中L／M比值；第8天测定血内毒素水平和进行肠道细菌DNA基因指纹分析；营养支持第5天测定营养治疗2h内的促胆囊收缩素和胃泌素含量；第8天统计感染性并发症的发生率和死亡率。结果 EIN组获得了良好的治疗效果，感染性并发症明显降低，肠道细菌多样性和通透性得到改善，APACHEⅡ计分和死亡率明显下降，EIN组出现暂时性的CCK分泌增高，但未增加疾病负担。结论 EIN能减轻疾病严重程度，改善肠道通透性，降低感染性并发症发生率。Objective To study the effect of ecoimmunonutrition （EIN） on gut permeability and occurrence of sepsis in patients with acute pancreatitis. Methods Seventy-six patients with acute pancreatitis were randomly divided into two groups ： parenteral nutrition （ PN ） group （ n = 38 ）, and enteral nutrition with lactobacillus plantarum supplement given through nasojejunal tube （ EIN group, n = 36 ）. The APACHE Ⅱ , Balthazar CT score were determined on admission and the 7th day after the management, gut barrier function was assessed by measurement of intestinal permeability （lactulose/rhamnose test ） and culture of nasogastrric aspirate was done on day 1 and day 8. Two hours＇ level of serum cholecystokinin （CCK） and gastrin were determined on the 5th day before and after giving EIN. Gut bacterial DNA fingerprints was analyzed by PCR. The rate of organ failure, septic complications, and mortality were determined on the 8th day. Results Clinical outcomes in 36 patients with EIN were better than that in 38 patients with PN. Septic complication rate was lower as compared with PN group. Intestinal permeability and gut microflora were improved. After 7 days, there were a significant reduction in the degree with disease severity in EIN group. Conclusion EIN enteral feeding can attenuate disease severity, improve intestinal oermeability status and clinical outcome of patients with acute pancreatitis.

关 键 词：胰腺炎 肠道营养 感染并发症 肠道通透性 

分 类 号：R686[医药卫生—骨科学]