不同剂量早期肠内营养对重症急性胰腺炎胃肠功能障碍患者的影响  

Effects of different doses of early enteral nutrition on gastrointestinal dysfunction in patients with severe acute pancreatitis

作　　者：孙波[1] 黄文娟 王胜[1] 余月华[2] 雷婕[3] 苏文智[1] 刘玉敏[1] 曹建华[1] SUN Bo;HUANG Wenjuan;WANG Sheng;YU Yuehua;LEI jie;SU Wenzhi;LIU Yumin;CAO Jianhua(Department of Hepatobiliary ,Surgeny,The First People's Hospital of Yinhcuna,Yinchuan 750001,China;Department of Gastroenterology,The First People's Hospital of Yinchuan,Yinchuan 750001,China;Clinic Pharmacy,The Frist Peoples Hospital of Yinchuan,Yinchuan 750001,China)

机构地区：[1]宁夏银川市第一人民医院肝胆外科,宁夏银川750001 [2]宁夏银川市第一人民医院消化内科,宁夏银川750001 [3]宁夏银川市第一人民医院临床药学室,宁夏银川750001

出　　处：《宁夏医学杂志》2019年第1期41-44,共4页Ningxia Medical Journal

基　　金：宁夏科技支撑计划项目(201513Y091)

摘　　要：目的观察不同剂量早期肠内营养(EEN)对重症急性胰腺炎(SAP)胃肠功能障碍患者喂养不耐受情况、炎性指标、肠黏膜屏障功能指标及预后的影响。方法将60例重症急性胰腺炎合并急性胃肠功能障碍Ⅱ级患者分为观察组(低剂量组)和对照组(常规剂量组)各30例。观察组EEN起始剂量为20 mL/h并连续使用7 d;对照组EEN起始剂量为20 mL/h,24 h后每隔12 h根据耐受性增加10 mL/h,直至目标热卡;2组EN能量不足部分均在3 d后启用肠外营养(PN)补充。比较2组患者第1周喂养不耐受率、感染率、死亡率、住院时间、住院费用,以及血浆二胺氧化酶(DAO)、D-乳酸、血清肿瘤坏死因子-α(TNF-α) C-反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)水平。结果第1周观察组喂养不耐受率明显低于对照组(9.0%、38.6%,P<0.05);观察组与对照组感染率、住院时间和住院费用组间比较差异均无统计学意义;观察组与对照组在EEN实施第1天、第3天和第7天,DAO、D-乳酸、TNF-α、CRP、PCT、IL-6,2组间同时间点比较差异均无统计学意义(P>0.05)。结论低剂量EEN能提高重症急性胰腺炎胃肠功能障碍患者喂养耐受性,但对感染率及预后无影响。Objective To observe the influence of different doses of enteral nutrition on feeding tolerance,inflammation indexes,intestinal barrier function index and prognosis in patients with severe acute pancreatitis with acute gastrointestinal dysfunction.Methods 60 patients of severe acute pancreatitis with acute gastrointestinal dysfunction II were randomly divided into treatment group(low-dose EN,n=30)and control group(conventional-dose EN,n=30).The treatment group received EN at 20 mL/h for7 days,supplemented by PN to achieve the target calories on the 3rd day and from the 8th day gradually increased to the full volume,while the control group received EN at 20 mL/h,with an addition of 10 mL/heavy 12 hours according to the tolerance and supplemented by parenteral nutrition(PN)to achieve the target calories(60%)on the 3rd day.We recorded the feeding tolerance,infection rate,death rates,average length of hospital stay,hospital cost,and levels of diamine oxidase(DAO),D-1actate,procalcitonin(PCT),C-reactive protein(CRP),interleukin-6(IL-6)and tumor necrosis factor(TNF-α)between the two groups.Results The incidence of feeding intolerance in the first week was significantly lower in the treatment group than in the control group(9.0 % vs.38.6%,P<0.05).No significant differences were found on infection rates,average length of hospital stay and hospital cost,between the two groups(P>0.05).On the previous day,3rd,and 7th day,no significant differences were found on the level of DAO,D-lactate,TNF-α,CRP,PCT and IL-6 between the two groups.Conclusion Lower dose of early enteral nutrition can improve the feeding tolerance of SAP patients with acute gastrointestinal dysfunction,but it does not influence the incidence of infections and prognosis.

关 键 词：重症急性胰腺炎 早期肠内营养 低剂量 急性胃肠功能障碍 

分 类 号：R657.51[医药卫生—外科学]