重症急性胰腺炎肠内营养治疗的效果观察  

Enteral nutrition treatment for severe acute pancreatitis

作　　者：饶智[1] 黄惠[1] 黄艺[1] 

机构地区：[1]新疆生产建设兵团农三师医院外科,新疆喀什844000

出　　处：《临床外科杂志》2010年第6期378-380,共3页Journal of Clinical Surgery

摘　　要：目的研究肠内营养（EN）支持治疗重症急性胰腺炎（SAP）的效果。方法将40例SAP患者随机分为EN支持治疗组20例和全胃肠外营养（TPN）支持治疗组20例。比较两组问血清C反应蛋白、前白蛋白、白蛋白水平，以及采取外科手术治疗率、感染率、死亡率和ICU治疗时问、住院时问的差异。结果两组在营养支持治疗后第14天的血清C反应蛋白水平均较营养支持治疗前明显下降（P〈0．05），前白蛋白均明显升高（P〈0．05）；在第14天血清白蛋白水平在EN组较营养支持治疗前轻度升高[（32．35±3．07）g/L比（36．87±2．38）g/L，P〈0．05]，TPN组无明显差异[（33．09±5．39）g／L比（35．20±3．41）g/L，P〉0．05]；两组间的手术治疗率（45％比55％，P〉0．05），死亡率（8．1％比7．5％，P〉0．05）和ICU治疗时间[平均11．5d（7～21d）比平均14．1d（5～20d），P〉0．05]无明显的差异；相对于TPN组，EN组可减少感染率（35％比60％，P〈0．05）并且缩短了住院时间[平均28．3d（18～92d）比平均38．7d（15—77d），P〈0．05]。结论EN能减少感染的发生并且缩短住院时间，疗效较好。Objective To investigate the efficacy of enteral nutrition support for the treatment of severe acute pancreatitis. Methods A total of 40 patients with severe acute panereatitis were randomized to receive either enteral nutrition （ n = 20） or total parenteral nutrition （ n = 20）. The levels of serum C - reactive protein, prealbumin and albumin, surgical intervention rate, infection rate, duration of hospital stay and mortality, as well as ICU stay duration, were compared between the two groups. There were 11 patients with alcoholic pancreatitis ,21 with pancreatitis of cholelithic etiology and 8 with idiopathic pancreatitis. Results The level of serum C - reactive protein was significantly decreased and that of prealbumin increased in both the enteral nutrition and the total parental nutrition groups at 14 days when compared with those before the nutrition supports （P 〈 0.05 for both）. There was a slight increase at 14 days in serum albumin level in the enteral nutrition group as compared with that before the nutrition administration （32.35 ± 3.07 g/L vs 36.87 ± 2.38 g/L,P 〈 0.05）. However, no significantly statistical difference in the serum albumin level was noted between before and after nutrition supports in the total parenteral nutrition group （ 33.09 ± 5.39 g/L vs 35.20 ± 3.41 g/L, P 〉 0.05 ）. Surgical intervention rate （45% vs 55%, P〉0.05）,mortality （8.1% vs7.5%,P〉0.05） and duration of ICU stay （11.5 days [range：7-21 days] vs 14.1 days [ range： 5 -20 days ] ,P 〉 0.05 ） were comparable between the groups. The infection rate and hospital stay were significantly reduced in the enteral nutrition group in comparison to the total parenteral nutrition group （28.3 days [ range： 18 - 92 days ] vs 38.7 days [ range： 15 - 77 days ] ; P 〈 0.05）. Coudusion Enteral nutrition support is effective in the treatment of severe acute pancreatitis by reducing infection rate and shortening duration of hospital stay.

关 键 词：重症急性胰腺炎 肠内营养 全胃肠外营养 

分 类 号：R657.51[医药卫生—外科学]