中度重症急性胰腺炎患者早期经鼻胃管与经鼻空肠管肠内营养的疗效对比  

Comparison of efficacy between nasogastric tube and nasojejunal tube enteral nutrition at the early stage of patients with moderately severe acute pancreatitis

作　　者：宋巍[1] 刘心娟[1] 杨立新[1] 金桐[1] 陈婧[1] 李秀芬[1] 史赛男 郝建宇[1] Song Wei;Liu Xinjuan;Yang Lixin;Jin Tong;Chen Jing;Li Xiufen;Shi Sainan;Hao Jianyu(Department of Gastroenterology,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院消化内科,100020

出　　处：《中华消化杂志》2021年第4期260-264,共5页Chinese Journal of Digestion

基　　金：北京市中医药科技发展资金资助项目(JJ2015-15);北京市医院管理局消化内科学科协同发展中心特色项目(XXT13)。

摘　　要：目的探讨不同肠内营养方式在中度重症急性胰腺炎(MSAP)治疗中的临床疗效、安全性和耐受性。方法前瞻性纳入2018年1月至2019年1月于首都医科大学附属北京朝阳医院住院治疗的65例MSAP患者,采用随机数字表法分为鼻胃管肠内营养(NGEN)组(35例)和鼻空肠管肠内营养(NJEN)组(30例),所有患者的肠内营养液均以24 h匀速持续泵入的方式喂养。比较两组患者的腹痛缓解时间、肠内营养开始时间、恢复经口进食时间、肠内营养1周时计算机断层扫描严重指数(CTSI)评分、营养状况、感染指标、住院时间、住院费用、置管费用和并发症发生情况。采用独立样本t检验和两独立样本的秩和检验进行统计学分析。结果NGEN和NJEN组患者的年龄、性别、BMI、入院时CTSI评分、入院时Ranson评分、腹痛缓解时间、肠内营养开始时间、恢复经口进食时间、肠内营养1周时CTSI评分、住院时间比较差异均无统计学意义(P均>0.05),两组均无死亡患者;NGEN组患者的住院费用、置管时间、置管费用均低于NJEN组[(4.0±1.0)万元比(4.4±0.9)万元、2.00 min(1.50 min,2.50 min)比11.50 min(9.50 min,12.75 min)、135.42元(135.42元,135.42元)比1313.30元(1231.20元,1823.72元)],差异均有统计学意义(t=2.342,Z=6.737、7.687,P均<0.01)。NGEN组MSAP患者入院时和肠内营养1周时白蛋白水平均高于NJEN组[(43.5±5.1)g/L比(41.0±4.0)g/L、(42.1±4.1)g/L比(39.5±4.4)g/L],差异均有统计学意义(t=2.135、2.486,P=0.04、0.02),但两组白蛋白下降程度比较差异无统计学意义(P>0.05)。NGEN和NJEN组患者营养相关并发症(腹胀、腹泻、胃潴留、管腔阻塞)和严重并发症(一过性器官功能衰竭和胰腺坏死合并感染等)的发生率比较差异均无统计学意义(P均>0.05)。结论NGEN用于MSAP的疗效和安全性与NJEN相当,且能减少患者的医疗费用,其操作简单,便于在基层医院开展。Objective To investigate the clinical efficacy,safety and tolerance of different enteral nutritional therapy in the treatment of moderately severe acute pancreatitis(MSAP).Methods From January 2018 to January 2019,65 patients with MSAP who were hospitalized in Beijing Chao-Yang Hospital,Capital Medical University were prospectively enrolled.According to random number table,the patients were divided into the nasogastric tube enteral nutrition(NGEN)group(35 cases)and the nasojejunal tube enteral nutrition(NJEN)group(30 cases).All the patients received enteral nutrition solution through continuously pumping at a constant speed for 24 h.The two groups were compared in the relief time of abdominal pain,time from admission to receiving enteral nutrition treatment,time to resume oral feeding,computed tomography severity index(CTSI)score 1 week after enteral nutrition,nutrition status,infection parameters,hospitalization time,hospitalization expenses and complications.Independent sample t test and rank sum test of two independent samples were used for statistical analysis.Results There were no significant differences in age,gender,body mass index(BMI),CTSI score and Ranson score at admission,relief time of abdominal pain,time from admission to receiving enteral nutrition treatment,time to resume oral feeding,CTSI score one week after enteral nutrition or hospitalization time between NGEN group and NJEN group(all P>0.05),and there was no death in both groups.The cost of hospitalization,catheterization time,cost of catheterization of NGEN group were all lower than those of NJEN group((40.0±10.0)thousand yuan vs.(40.4±9.0)thousand yuan;2.00 min(1.50 min,2.50 min)vs.11.50 min(9.50 min,12.75 min);135.42 yuan(135.42 yuan,135.42 yuan)vs.1313.30 yuan(1231.20 yuan,1823.72 yuan)),and the differences were statistically significant(t=2.342,Z=6.737 and 7.687,all P<0.01).The albumin levels of MSAP patients of the NGEN group at admission and 1 week after enteral nutrition were both higher than those of NJEN group((43.5±5.1)g/L vs.(4

关 键 词：中度重症急性胰腺炎 肠道营养 鼻胃管 持续泵入 

分 类 号：R576[医药卫生—消化系统]