免疫调控营养对重症急性胰腺炎的治疗作用  

Therapeutic effect of immune regulating nutrition on severe acute pancreatitis

作　　者：张军港[1] 赵刚[1] 钦琦[1] 刘林[1] 刘洋[1] 邓世昌[1] 吴河水[1] 王春友[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院胰腺外科中心,武汉430022

出　　处：《中华消化外科杂志》2010年第5期350-352,共3页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（30600594）

摘　　要：目的 探讨免疫调控营养对重症急性胰腺炎（SAP）患者的治疗作用.方法 前瞻性分析2008年2月至2009年10月华中科技大学同济医学院附属协和医院收治的80例SAP患者的临床资料.将80例SAP患者按照配对的方法分为常规营养组（CN组）和免疫调控营养组（IRN组）,每组40例.CN组接受分阶段营养支持,而IRN组则在常规营养治疗基础上联合应用ω-3多不饱和脂肪酸（ω-3 PUFA）和谷氨酰胺.评估两组患者在治疗第1、4、7、10、14天的APACHEⅡ评分,比较两组患者住院期间肺部感染、腹腔感染、脓毒血症发生率,手术干预率,ICU时间,住院时间和病死率的差异.采用t检验和χ^2检验分析检测数据.结果 IRN组患者APACHEⅡ评分在治疗的第4、7天分别为（15.3±1.8）、（9.0±1.8）分,明显低于CN组的（20.0±2.7）、（13.3±2.4）分,两组比较,差异有统计学意义（t=3.3,2.8,P〈0.05）,IRN组在第10、14天仍低于CN组,但两组比较,差异无统计学意义（t=0.7,0.6,P〉0.05）.IRN组肺部感染、腹腔感染发生率和手术干预率分别为18%（7/40）、13%（5/40）和5%（2/40）,显著低于CN组的38%（15/40）、33%（13/40）和20%（8/40）,两组比较,差异有统计学意义（χ^2=4.0,4.6,4.1,P〈0.05）.IRN组脓毒血症发生率为5%（2/40）,低于CN组的8%（3/40）,但两组比较,差异无统计学意义（χ^2=0.0,P〉0.05）.IRN组的ICU时间和住院时间分别为（5.4±1.6）、（38.6±9.3）d,而CN组分别为（7.8±2.8）、（43.1±11.6）d,两组比较,差异有统计学意义（t=2.7,3.7,P〈0.05）.IRN组和CN组病死率分别为5%（2/40）和8%（3/40）,两组比较,差异无统计学意义（χ^2=0.0,P〉0.05）.结论 在SAP患者营养支持中添加ω-3PUFA及谷氨酰胺可调控SAP早期过度炎症反应,有效减少严重感染的发生,降低手术率,缩短ICU时间及住院时间,对SAP具有积极的治疗作用.Objective To explore the therapeutic effect of immune regulating nutrition on severe acute pancreatitis （SAP）. Methods The clinical data of 80 patients with SAP who were admitted to the Union Hospital of Huazhong University of Science and Technology from February 2008 to October 2009 were prospectively analyzed. The 80 patients were equally divided into conventional nutrition （CN） group and immune regulating nutrition （IRN） group. Patients in the CN group received CN support, while patients in the IRN group were supplemented with ω-3 polyunsaturated fatty acid （ω-3 PUFA ） and glutamine at the basis of CN support.APACHE Ⅱ scores were evaluated at day 1, 4, 7, 10, 14 in the course of treatment. The differences in the incidence of pulmonary and abdominal infection, sepsis, and other clinical parameters including operation intervention, mortality, length of ICU and hospital stay between the two groups were compared. All data were analyzed using the t test and chi-square test. Results The APACHE Ⅱ scores of patients in the IRN group were 15.3 ± 1.8 and 9.0 ± 1.8 at day 4 and 7, which were significantly lower than 20.0 ± 2.7 and 13.3 ± 2.4 in the CN group, respectively （t = 3.3, 2. 8, P 〈 0.05）. The APACHE Ⅱ scores of patients in the IRN group at day 10and 14 were also lower than those in the CN group, while there was no significant difference （t =0. 7, 0. 6, P〉0.05）. The incidences of pulmonary and abdominal infection and surgical intervention rate in the IRN group were 18% （7/40）, 13% （5/40） and 5% （2/40）, which were significantly lower than 38% （15/40）, 33% （13/40）and 20% （8/40） in the CN group, respectively （χ^2 =4.0, 4.6, 4.1, P〈0.05）. The incidence of sepsis in the IRN group was 5% （2/40）, which was lower than 8% （3/40） of the CN group, while there was no significant difference between the two groups （ χ^2 =0.0, P 〉0.05 ）. The average lengths of ICU and hospital stay in the IRN group were （5.4 ± 1.6 ） days and （ 38.6 ± 9

关 键 词：重症急性胰腺炎 免疫调控 营养 不饱和脂肪酸 谷氨酰胺 

分 类 号：R657.51[医药卫生—外科学]