经鼻空肠管进行肠内营养对急性重症胰腺炎患者预后的影响  

Effects of enteral nutrition by naso-jejunal tube on the prognosis of patients with severe acute pancreatitis prognosis

作　　者：刘益娟 吴婷[1] 张琳[1] 

机构地区：[1]福建医科大学附属第一医院消化内科,福建福州350000

出　　处：《实用临床医药杂志》2013年第21期84-86,90,共4页Journal of Clinical Medicine in Practice

基　　金：中国高校医学期刊临床专项资金(11321128)

摘　　要：目的观察经鼻空肠管进行肠内营养(EN)对急性重症胰腺炎(SAP)患者预后的影响。方法将45例SAP患者随机分为3组,即完全肠外营养组(TPN组),经鼻空肠管进行常规EN组(EN组),经鼻空肠管进行添加谷氨酰胺的EN组(Gln组),每组15例。治疗前及治疗后第1、7、14 d分别检测3组患者血白蛋白、C反应蛋白(CRP)及内毒素水平,并进行急性生理功能和慢性健康状况(APACHE)Ⅱ与Ranson评分,同时观察患者体质量、肠功能及并发症发生情况。结果治疗后第7天,3组白蛋白、体质量均较治疗前明显下降,第14天恢复,其中Gln组回升最明显。治疗后第14天,3组APACHE-Ⅱ及Ranson评分均低于治疗前,但3组间比较,差异无统计学意义。治疗第7天,Gln组CRP及内毒素水平低于其他2组,第14天Gln组与EN组比较无显著差异,但均低于TPN组。Gln组并发症发生率最低,明显低于TPN组,略低于EN组。治疗前后3组肠功能评分比较,差异均无统计学意义,但Gln组肠功能改善情况略优于TPN组和EN组。结论添加谷氨酰胺的EN可改善SAP患者炎症反应,减少细菌移位,降低肠源性感染几率,对患者的预后具有重要作用。Objective To investigate the effects of enteral nutrition （EN） by naso- jejunal tube on the prognosis of patients with severe acute panereatitis （SAP）. Methods Forty - five pa- tients with SAP were randomly divided into three groups： total parenteral nutrition group （TPN group）, conventional EN group （EN group） and glutamine- enhanced EN group （Glu group）, 15 cases in each group. The levels of albumin, C reactive protein （CRP） and endotoxin in three groups were detected, and acute physiological and chronic health evaluation （APACHE） H and Rsnson scores were measured before treatment and 7, 14 d after treatment. Besides, body weight, intesti- nal function and incidence of complications were observed. Results 7 d after treatment, the levels of albumin and body weight in three groups were all lower than before treatment, but recovered on day 14, in which the recovery in Gln group was the most significant. 14 days after treatment, A- PACHE ]~ and Rsnson scores in three groups decreased obviously compared with treatment before, but there were no significant differences among three groups. On day 7, the levels of CRP and en- dotoxin in Glu group were significantly lower than other two groups. On day 14, the levels of CRP and endotoxin in Gln and EN groups had no significance difference, but they were lower than that in TPN group. The incidence of complications in Gln group was the lowest, evidently lower than in TPN group and slightly lower than in EN group . There were no statistical significance among three groups regarding the intestinal function scores. Conchtsion EN with Gin can improve the inflammatory response of patients with SAP, reduce bacterial translocation, reduce the probability of enterogenic, which is very important for the prognosis of patients.

关 键 词：急性重症胰腺炎 肠内营养 肠外营养 谷氨酰胺 

分 类 号：R657.7[医药卫生—外科学]