重症急性胰腺炎早期肠内营养途径的临床应用价值  

Clinical Application Value of Enteral Nutrition in Early Stage of Severe Acute Pancreatitis

作　　者：王英[1] 任婵[1] 董丽红 祝艳翠[1] 王飞[1] 单可记[1] WANG Ying;REN Chan;DONG Li-hong;ZHU Yan-cui;WANG Fei;SHAN Ke-ji(Dept. of Critical Care Medicine,The 1st Affiliated Hospital of Kunming Medical University,Kunming Yunnan650032,China)

机构地区：[1]昆明医科大学第一附属医院重症医学科

出　　处：《昆明医科大学学报》2019年第8期72-77,共6页Journal of Kunming Medical University

基　　金：云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目(2014FZ013,2015FB050)

摘　　要：目的探讨重症急性胰腺炎(SAP)早期经口肠内营养支持治疗的有效性和安全性。方法回顾性分析,2011 年1 月至2018 年3 月收住昆明医科大学第一附属医院重症医学科的重症急性胰腺炎患者65 例,均在液体复苏、抑制胰酶分泌及活性、抗感染、胃肠减压、抑酸、纠正内环境紊乱、保护重要脏器功能等综合治疗的基础上,给予肠内营养支持治疗。根据肠内营养支持的不同途径分为:经口饮食组(A 组) 23 例,鼻空肠组(B组) 22 例,鼻胃管组(C 组) 20 例,观察比较三组患者进食时间、住院时间、住院费用、感染率、并发症发生率、手术中转率、病死率、C-反应蛋白(CRP)、氧合指数以及血清白蛋白的变化情况。结果A 组和B 组、C组比较,进食时间无差异,但住院时间、住院费用均明显低于B组和C 组,差异有统计学意义(P<0.01)。C 组感染率高于A 组和B 组,但差异无统计学意义(P>0.05)。A 组和B 组、C 组比较,A 组C-反应蛋白下降更快、氧合指数、血清白蛋白升高更明显,但差异无统计学意义(P>0.05),并发症发生率、手术中转率、病死率均无统计学差异(P>0.05)。结论重症急性胰腺炎患者早期经口饮食是安全有效和可行的。Objective To investigate the efficacy and safety of early oral diet in the enteral nutrition pathway of severe acute pancreatitis(SAP). Methods A retrospective analysis was made in 65 patients with severe acute pancreatitis in the Department of Critical Care Medicine, the First Affiliated Hospital of Kunming Medical University from January 2011 to March 2018. Enteral nutrition support treatment was given to all in addition to liquid resuscitation, inhibition of pancreatic enzyme secretion and activity,anti-infection on the basis of comprehensive treatment such as gastrointestinal decompression,acid suppression,correction of internal environmental disorders, and protection of important organ functions. According to different routes of enteral nutrition support, there were 23 cases in the oral diet group (group A),22 cases in the nasal jejunum group (group B),and 20 cases in the nasogastric tube group (group C). Feeding time, hospitalization time, hospitalization expenses,infection rate,complication rate,surgical turnover rate,mortality,C-reactive protein (CRP), oxygenation index,and changes in serum albumin in the three groups were observed and compared.Results There were no differences in the eating time between group A and group B and group C,but the hospitalization time and hospitalization expenses were significantly lower in group A than those in group B and group C (P< 0.01). The infection rate of group C was higher than those of group A and group B,but the difference was not statistically significant (P> 0.05). Compared with group B and group C,group A responded with a faster decrease in protein, oxygenation index, and serum albumin elevation, but the differences were not statistically significant(P> 0.05). Complication rate and surgical conversion rate also showed no statistical significance. There was no statistical difference in mortality. Conclusion Early oral diet in patients with severe acute pancreatitis is safe, effective and feasible.

关 键 词：重症急性胰腺炎 肠内营养途径 经口饮食 

分 类 号：R574[医药卫生—消化系统]