大黄联合早期肠内营养治疗重症急性胰腺炎的临床研究  

Clinical research of rhubarb combining with early enteral nutrition on severe acute pancreatitis

作　　者：吴小丽[1] 陶利萍[1] 黄庆科[1] 陈小微[1] 余震[2] 

机构地区：[1]温州医学院附属第一医院消化内科 [2]温州医学院附属第一医院普外科

出　　处：《中国临床药理学与治疗学》2011年第1期61-66,共6页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：温州市科技计划项目(Y20060245);浙江省医学重点扶植学科资助(07-F03)

摘　　要：目的:观察大黄联合早期肠内营养治疗重症急性胰腺炎(SAP)的疗效。方法:将64例SAP患者随机分为3组:全肠外营养(TPN)组20例,早期肠内营养(EEN)组23例和大黄联合早期肠内营养(REN)组21例。观察3组患者住院费用、住院时间、死亡人数、肠道功能恢复时间、A-PACHEⅡ评分、并发症,检测血浆降钙素原(PCT)、C-反应蛋白(CRP)、前白蛋白、CD3%、CD4%、CD8%、CD4/CD8、IgG、IgA及IgM并进行比较。结果:REN组无1例死亡,EEN组死亡1例,TPN组2例;REN组肠道功能恢复时间(2.6±0.7)d,平均住院天数(24±4)d,费用(5.5±0.7)万元,均低于其他两组(TPN组,P<0.01;EEN组,P<0.05)。治疗2周后REN组APACHE-II评分由11.8±2.4下降为3.1±1.0,CRP由(151.1±45.6)mg/L下降至(16.6±2.1)mg/L,PCT阳性例数由19例下降为2例(P<0.01),与其他两组比较,均下降更低(TPN组,P<0.01;EEN组,P<0.05)。REN组血前白蛋白由(121±9)升高为(315±21)mg/L(P<0.01),比TPN组上升更显著(P<0.01);REN组IgG、IgA、IgM、CD4%、CD3%、CD4/CD8均比其他两组上升更明显(TPN组,P<0.01;EEN组,P<0.05),而CD8%下降更显著(TPN组,P<0.01;EEN组,P<0.05)。结论:REN治疗SAP是有效的,促进消化道功能恢复,改善SAP患者营养和免疫状况,降低炎症反应,缩短住院时间,减少医疗费用,优于TPN及EEN。AIM ： To research the effects of rhubarb combining with early enteral nutrition on severe acute pancreatitis（SAP）. METHODS ： 64 patients with SAP were randomly received one of the three therapies below： 20 patients were treated with total parenteral nutrition（TPN）,23 patients were treated with early enteral nutrition（EEN）,and 21 patients were treated with rhubarb combining with early enteral nutrition（REN）.The hospitalization cost,length of stay,mortality,recovery time of intestinal function and score of APACHEⅡgrade were observed.The positive rate of plasma procalcitonin（PCT）,the levels of C-reactive protein（CRP）,pre-albumin,the percentage of CD 3,CD 4,CD 8,CD 4/CD 8 ratio and IgG,IgA,IgM were detected and compared. RESULTS ：There was no patient died in REN group,but 1 in EEN group and 2 in TPN group.The recovery time of intestinal function in REN group was（2.6 ± 0.7） days,the length of stay was（24±4） days,the hospitalization cost was（5.5 ± 0.7） thousands yuan,which were obviously shorter than those in the other groups（TPN group,P 0.01;EEN group,P 0.05）.After two-week therapy,the score of APACHEⅡgrade in REN group was decreased from 11.8 ± 2.4 to 3.1 ± 1.0（P 0.01）,which was lower than that in the TPN and EEN group（TPN group,P 0.01;EEN group,P 0.05）.In addition,the level of CRP and the positive rate of PCT in REN group was respectively decreased（P 0.01）,which were both lower than those in the other groups（EEN group,P 0.05;TPN group,P 0.01）.The level of plasma pre-albumin in REN after two-week therapy was higher than before[（315±21） mg/L vs（121±9） mg/L,P 0.01 ],which was also higher than that in TPN group（P 0.01）.After two-week treatment in REN group,the percentages of CD 3,CD 4 and CD 4/CD 8,IgG,IgA,IgM were increased,while the percentage of CD 8 was decreased,which were all of significant differences with those in EEN and TPN group（TPN,P 0.01;EEN,P 0.05）.Besides,CD 4/CD 8 after two-week treatment in REN group was significa

关 键 词：重症急性胰腺炎 早期肠内营养 大黄 全肠外营养 

分 类 号：R657.51[医药卫生—外科学]