重症急性胰腺炎患者出现肠源性感染的炎症指标与肠内营养支持治疗分析  

Inflammatory indexes of severe acute pancreatitis patients complicated with intestinal infections and clinical effect of enteral nutrition support

作　　者：吕一鸣[1] 黄玉军[1] 俞雷来 曹利平[2] 阙日升[3] 

机构地区：[1]嵊州市中医院外科,浙江嵊州312400 [2]浙江大学医学院附属邵逸夫医院肝胆胰外科,浙江杭州310016 [3]浙江大学医学院附属第二医院普通外科,浙江杭州310009

出　　处：《中华医院感染学杂志》2017年第2期373-376,共4页Chinese Journal of Nosocomiology

基　　金：浙江省中医药科技计划项目(2009B620014)

摘　　要：目的探究重症急性胰腺炎患者出现肠源性感染时的WBC、CRP及内毒素水平变化及肠内营养支持治疗的临床效果,为及早控制肠源性感染提供参考。方法选择2011年4月-2016年5月在医院进行治疗的64例重症急性胰腺炎并发肠源性感染患者为研究对象,入院后给予其肠内营养支持治疗,对比治疗前后患者的WBC、CRP及内毒素水平,并就治疗前后患者的各细胞免疫功能指标及营养相关性指标进行比较。结果给予肠内营养支持治疗后,并发肠源性感染患者的WBC、CRP及内毒素水平分别为(15.05±1.58)×109/L、(101.27±18.29)mg/L、(0.45±0.14)EU/ml,上述指标均有所好转,与治疗前的(18.22±2.36)×109/L、(165.24±31.52)mg/L、(0.97±0.23)EU/ml比较差异有统计学意义(P<0.05);治疗后,肠源性感染患者的CD3、CD4及CD4/CD8分别为(71.03±4.24)%、(41.57±4.46)%、1.68±0.33,明显高于治疗前的(61.25±5.48)%、(30.14±3.18)%、1.12±0.24,治疗后的CD8为(25.73±2.58)%,明显低于治疗前的(28.16±3.25)%,差异有统计学意义(P<0.05);治疗后,肠源性感染患者的ALB、PA以及TF水平分别为(36.28±5.49)g/L、(331.58±41.28)mg/L、(3.24±0.76)g/L,高于治疗前的(31.47±4.21)g/L、(221.45±28.16)mg/L、(2.13±0.51)g/L,各项营养指标提升幅度明显(P<0.05)。结论重症急性胰腺炎患者在出现肠源性感染时,其WBC、CRP及内毒素明显偏高,通过给予其肠内营养支持治疗,可以降低其WBC、CRP及内毒素水平,其细胞免疫功能和营养状况得到显著改善,对于缓解其肠源性感染症状,减轻患者痛苦能够发挥积极作用。OBJECTIVE To investigate the changes of levels of WBC, CRP, and endotoxin of severe acute pancrea- titis patients complicated with intestinal infections and observe the clinical effect of enteral nutrition support so as to provide guidance for early control of the intestinal infections. METHODS A total of 64 severe acute pancreatitis patients complicated with intestinal infections who were treated in hospitals from Apr 2011 to May 2016 were recruited as the study objects and were given enteral nutrition support therapy after admission to hospitals. The levels of WBC, CRP, and endotoxin were compared before and after the treatment, and the cellular immune function indexes and nutrition-related indexes were observed and compared before and after the treatment. RESULTS The levels of WBC, CRP, and endotoxin of the patients complicated with intestinal infection were respectively （15.05 ±1.58） × 10^9/L, （101.27 ± 18.29） mg/L, and （0.45±0. 14） EU/ml after the enteral nutrition support therapy and were respectively （18.22 ± 2.36） × 10^9/L, （165. 24±31. 52）mg/L, and （0. 97 ±0.23）EU/ml before the treatment, and there was significant difference （P〈0.05）. The levels of CD3, CD4, and CD4/CD8 of the patients complicated with intestinal infection were respectively （71.03±4.24） %, （41.57±4.46） %, and 1.68±0.33 after the treatment, significantly higher than （61.25±5.48）%, （30.14 ± 3.18）%, and 1.12 ±0.24 before the treatment; the CD8 level was （25.73± 2.58）% after the treatment, significantly lower than （28.16 ±3.25）% before the treatment（P〈0.05）. The levels of ALB, PA, and TF of the patients with intestinal infection were respectively （36.28±5.49）g/L, （331.58±41.28）mg/L, and （3.24±0.76）g/L after the treatment, higher than （31.47± 4.21）g/L, （221.45±28.16）mg/L, and （2.13±0.51）g/L before the treatment, and the nutrition-related indexes were remarkably elevated （P〈0.05）. CONCLUSION The levels of WBC, CRP, and endotoxin of t

关 键 词：重症急性胰腺炎 白细胞计数 C-反应蛋白 内毒素 肠源性感染 肠内营养支持 

分 类 号：R576[医药卫生—消化系统]