肠内营养对急性胰腺炎患者肠粘膜通透性及细菌移位的影响  

Influences of enteral nutrition on intestinal permeability and bacterial translocation in patients with acute pancreatitis

作　　者：李颖[1] 方喜[1] 吴俊伟[1] 

机构地区：[1]广东省汕头市中心医院普外科,广东汕头515041

出　　处：《中国现代普通外科进展》2010年第12期945-949,共5页Chinese Journal of Current Advances in General Surgery

基　　金：2009年广东省医学科学技术研究基金课题(A2009642)

摘　　要：目的:比较肠内营养及肠外营养支持治疗对急性胰腺炎肠粘膜通透性及细菌移位的影响以及临床效果。方法:将80例急性胰腺炎患者随机分为肠外营养(PN)组和肠内营养(EN)组,分别应用肠外营养和肠内营养支持治疗,比较2组临床数据、生化指标的改变以及并发症、感染率、死亡率、住院天数及费用,同时比较外周血中血浆谷氨酰胺浓度、全血细菌DNA和尿中乳果糖/甘露醇(L/M)比值。结果:2组血清白蛋白、血清前白蛋白、血清转铁蛋白显著升高(P<0.05);血糖、血淀粉酶明显降低(P<0.05)。PN组病程后期的IgA较早期明显降低(P<0.05);EN组无明显变化。并发症、感染率、死亡率、住院天数和治疗费用等方面,EN组均低于PN组(P<0.05)。EN组的血浆谷氨酰胺浓度高于PN组(P<0.01),EN组病程后期L/M比值及外周血中细菌DNA阳性率低于PN组(P<0.01)。结论:肠内营养对维护肠粘膜屏障功能、减少细菌移位、减少并发症起着重要的作用。Objective： To investigate the influences and clinical effects of enteral nutrition on intestinal permeability and bacterial translocation in patients with acute pancreatitis.Methods： Eighty Patients with acute pancreatitis were randomized into 2 groups： enteral nutrition（EN） group and parenteral nutrition（PN） group.Then the clinical data,biochemical,complications,infection,mortality,hospital stay and costs of the 2 groups were analyzed.In addition,glutamine concentration in peripheral blood plasma,whole blood bacterial DNA and urine lactulose/mannitol（L/M） ratio were compared.Results： In both groups,serum albumin,prealbumin,serum transferring significantly went higher（P0.05）,while glucose,serum amylase obviously decreased compared with the level of admission（P0.05）.In PN group,the late course of IgA decreased significantly than the earlier（P0.05） and there was no change in EN group.Complications,infection,mortality,hospital stay and costs in EN group were lower than those in PN group（P0.05）.Plasma glutamine concentration in EN group was higher than that in PN group（P0.01）.The positive rates of late course L/M,bacteria in peripheral blood DNA in EN group were lower than those in PN group（P0.01）.Conclusion： Enteral nutrition plays an important role on maintaining intestinal barrier function and reducing bacterial translocation and complications.

关 键 词：肠内营养 急性胰腺炎 肠粘膜通透性 细菌移位 

分 类 号：R657.51[医药卫生—外科学]