肠外营养与肠内营养联合治疗重症胰腺炎临床研究  

Clinical research on combined therapy of total parenteral nutrition with enteral nutrition for severe acute pancreatitis

作　　者：张海 余立群[1] 方春华[1] 程斌[2] 

机构地区：[1]黄石市中心医院消化内科,湖北黄石435000 [2]华中科技大学同济医学院同济医院,湖北武汉430030

出　　处：《胃肠病学和肝病学杂志》2008年第5期417-419,共3页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的评价全胃肠外营养(TPN)和肠内营养(EN)联合应用对重症急性胰腺炎(SAP)的治疗效果,明确全胃肠外营养与肠内营养在重症急性胰腺炎中的作用。方法采用前瞻性、对照、开放式临床研究,将确诊为重症急性胰腺炎的患者分为TPN治疗组和TPN+EN联合治疗组,共有101例患者按要求完成试验,其中TPN治疗组56例,TPN+EN联合治疗组45例。重症急性胰腺炎的诊断依据采用1992年亚特兰大国际会议分类标准。重症急性胰腺炎严重度评估依据:Ranson标准、APACHEⅡ评分、Balthazar CT积分。结果两组患者入院时年龄、性别及重症急性胰腺炎严重度评分诸方面均无显著性差异。与TPN治疗组相比,TPN+EN联合治疗组患者的APACHEⅡ评分及Binder合并症积分明显改善;并发症和平均住院时间明显缩短,住院费用明显降低,病死率降低(0%vs7·5%)。但血清淀粉酶和乳酸脱氢酶活性治疗前后无明显变化。结论全胃肠外营养和肠内营养联合应用可显著改善重症急性胰腺炎患者的营养状况及预后,缩短住院时间,降低住院费用。Objective To assess the therapeutic efficacy of total parenteral nutrition （TPN） combined with enteral nutrition （EN） in patients with severe acute pancreatitis （SAP）. Methods In this prospective, open-label and clinical trial, 101 consecutive patients with diagnosis of severe acute pancreatitis were enrolled. Fifty-six patients were allocated in total parenteral nutrition group and 45 patients ＂in total parenteral nutrition combined with enteral nutrition group. ＂The diagnostic criteria of severe acute pancreatitis was made upon classity by standard in the international rivers of 1992 Atlanta. The severity of severe acute pancreatitis was slso ascertained based on Ranson＇ s criteria, APACHE Ⅱ or Bahhazar CT scoring. Results There were no statistical differences between two groups in age, gender and severity of severe acute pancreatitis. Compared with total parenteral nutrition group, patients in total parenteral nutrition combined with enteral nutrition group had a obvious improvement in APACHE Ⅱ and Binder＇ s scoring and a extremely reduction in complication, hospitalization days, hospitalization expenses and mortality. However, serum amylase and lactate dehydrogenase activity kept in the same level between two groups. Conclusion This study indicates that such combination therapy can improve the prognosis and undernutrition of severe acute pancreatitis.

关 键 词：重症急性胰腺炎 肠内营养 全胃肠外营养 联合治疗 

分 类 号：R576[医药卫生—消化系统]