急性重症胰腺炎患者营养支持的临床研究  

Clinical study on nutrition support in patients with severe acute pancreatitis

作　　者：胡轶鹏[1] 陈兵[1] 

机构地区：[1]天津医科大学第二医院急诊科,天津300211

出　　处：《临床荟萃》2011年第13期1124-1127,共4页Clinical Focus

摘　　要：目的探讨急性重症胰腺炎营养支持的治疗效果。方法将96例患有急性重症胰腺炎的患者随机分成对照组和治疗组。对照组给予全肠外营养,通过中心静脉注入;而治疗组在不同阶段给予肠外营养与肠内营养治疗。监测营养状况、急性阶段反应、胰腺损害、肠黏膜穿孔和免疫功能等指标。结果与对照组相比治疗组患者体质量和前白蛋白都有所增加(P<0.05),但是白蛋白没有显著的增加。急性生理和慢性健康状态(APACHEⅡ)评分在治疗7天后下降,然而对照组APACHEⅡ评分在第11天下降。肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)和血清C反应蛋白的浓度下降时间在治疗组(第4天下降)要早于对照组(第7天下降)。在对照组和治疗组均没有发现胰腺器质性改变。内毒素浓度和尿乳果糖(L)∶甘露醇(M)比例在治疗组没有改变,但是这两个指标在对照组有明显的升高。与治疗组相比,对照组的CD4:CD8 T细胞比例和IgG浓度明显下降(P<0.05)。结论与全肠外营养相比,肠外营养与肠内营养混合治疗能改善患者营养状况,缓解急性期反应。与对照组相比,治疗组的肠黏膜完整性和免疫功能都能受到有效的保护。肠内营养不会刺激胰腺分泌并且避免了胰腺炎症的扩大。适当的给予肠内与肠外营养对于治疗急性重症胰腺炎有一定效果。Objective To investigate the effect of nutritional support therapy on severe acute pancreatitis（SAP）.Methods A total of 96 patients with SAP were divided randomly into control group and treatment group.The former group received total parenteral nutrition（TPN） via central venous infusion,while parenteral nutrition（PN） and enteral nutrition（EN） therapies were applied in different phases for the latter group.The nutrition status,acute phase responses,pancreas lesions,enteric mucosa penetrability and immune functions were monitored.Results Body mass and prealbumin concentration were increased in treatment group,compared to those in control group（P〈0.05）,but albumin concentration did not change significantly.Acute Physiology and Chronic Health Evaluation Ⅱ（APACHE Ⅱ） scores decreased after 7 days of treatment,whereas the scores of control group decreased on the 11th day.Concentrations of tumor necrosis factor-α（TNF-α）,interleukine-6（IL-6） and serum C reactive protein（CRP） dropped earlier in treatment group（on the 4th day） than those in control group（on the 7th day）.No statistic difference was observed in pancreatic lesions between control group and treatment group.Concentration of endotoxin and lactulose/manicol（L∶M） ratio of urine did not change in treatment group,but those in control group were elevated markedly.Compared with treatment group,CD4：CD8 T cells ratio and immunoglobulin G（IgG） concentration in control group decreased significantly（P〈0.05）.Conclusion Compared to TPN,the combined therapy of EN and PN could improve the nutrition status and relieve the acute phase response obviously.Moreover,the integrity of enteric mucosa and immune function were protected more effectively in treatment group than in control group.On the other hand,EN did not simulate the excretion of pancreas and avoid exaggerating the inflammation of pancreas.Thus,appropriate application of PN and EN appears to be more effective for patients with SAP.

关 键 词：胰腺炎 急性坏死性 营养支持 胃肠外营养 肠道营养 

分 类 号：R576.1[医药卫生—消化系统]