腹内压监测对于实施早期肠内营养急性胰腺炎患者疗效评估的作用分析  

Assessment of effects of intra-abdominal pressure monitoring on evaluating early enteral nutrition in patients with acute pancreatitis

作　　者：葛梓[1] 曹隽[1] 赵晖[1] 马可[1] 苏文涛 夏志洁[1] Ge Zi;Cao Jun;Zhao Hui;Ma Ke;Su Wentao;Xia Zhijie(Department of Criticle Care Medicine,Baoshan Branch of Huashan Hospital Affiliated to Fudan University,200000,Shanghai,China)

机构地区：[1]复旦大学附属华山医院宝山院区急重症医学科,上海200000

出　　处：《中华危重病急救医学》2022年第6期630-634,共5页Chinese Critical Care Medicine

基　　金：上海市科委科技支撑计划医学重点项目(16411954400);上海市经济和信息化委员会专项研究项目(201601028);复旦大学附属华山医院北院科研启动基金(KY2018-392)。

摘　　要：目的探索腹内压(IAP)监测对评估急性胰腺炎(AP)早期肠内营养(EN)患者疗效的作用。方法收集复旦大学附属华山医院宝山院区2020年7月至2021年6月急重症医学科AP患者的临床资料,根据治疗方案将患者分为无胃肠减压+禁食组、有胃肠减压+禁食组和有胃肠减压+留置空肠管24 h内EN组。分析3组患者治疗前后白细胞计数(WBC)、降钙素原(PCT)、血清淀粉酶(AMY)及IAP下降幅度(降幅)和经口进食启动时间等数据。结果有胃肠减压+留置空肠管24 h内EN组患者WBC、PCT、AMY及IAP降幅均明显大于无胃肠减压+禁食组和有胃肠减压+禁食组〔WBC降幅(×10^(9)/L):-1.72±0.74比-0.68±0.36、-1.23±86.97,PCT降幅(μg/L):-3.14±5.19比0.06±0.48、-1.57±0.78,AMY降幅(U):-148.43±75.89比-74.85±78.84、-93.78±1.17,IAP降幅(cmH_(2)O,1 cmH_(2)O≈0.098 kPa):-4.82±1.66比0.36±1.32、-3.22±4.36,均P<0.05〕。无胃肠减压+禁食组和有胃肠减压+留置空肠管24 h内EN组患者IAP降幅数值与WBC、PCT、AMY变化均无相关性(均P>0.05);有胃肠减压+禁食组患者IAP降幅趋势与AMY变化呈正相关(r=0.65,P<0.001)。有胃肠减压+留置空肠管24 h内EN组患者经口进食启动时间明显短于无胃肠减压+禁食组和有胃肠减压+禁食组(h:89.538比111.273、10^(9).714),差异有统计学意义(P<0.05)。结论IAP监测作为急诊评估AP患者早期行EN的疗效手段,具有简单易行、高效合理的优点,较以往经验性治疗、开放经口进食有更为客观的依据。Objective To explore the role of intra-abdominal pressure(IAP)monitoring in evaluating the efficacy of early enteral nutrition(EN)in patients with acute pancreatitis(AP).Methods The clinical data were collected from the AP patients in department of criticle care medicine of Baoshan Branch of Huashan Hospital Affiliated to Fudan University from July 2020 to June 2021.The patients were divided into three groups according to their treatments:no gastrointestinal decompression with fasting group,gastrointestinal decompression with fasting group,gastrointestinal decompression with indwelling jejunal tube within 24 hours group.The data of white blood cell(WBC),procalcitonin(PCT),serum amylase(AMY)and IAP were analyzed before and after treatment,the initiation time oral feeding were also analyzed.Results The decrease of WBC,PCT,AMY,and IAP in gastrointestinal decompression with indwelling jejunal tube within 24 hours group were significantly greater than those in the other groups[WBC(×10^(9)/L):-1.72±0.74 vs.-0.68±0.36,-1.23±86.97;PCT(μg/L):-3.14±5.19 vs.0.06±0.48,-1.57±0.78;AMY(U):-148.43±75.89 vs.-74.85±78.84,-93.78±1.17;IAP(cmH_(2)O,1 cmH_(2)O≈0.098 kPa):-4.82±1.66 vs.0.36±1.32,-3.22±4.36,all P<0.05].There were no correlation between the changes of IAP and the changes of WBC,PCT or AMY in the non-gastrointestinal decompression with fasting group and the gastrointestinal decompression with indwelling jejunal tube within 24 hours group(all P>0.05).The decreasing trend of IAP in patients with gastrointestinal decompression with fasting group was positively correlated with the change of AMY(r=0.65,P<0.001).The initiation time of oral feeding in gastrointestinal decompression with indwelling jejunal tube within 24 hours group was significantly shorter than that in the other groups(hours:89.538 vs.111.273,10^(9).714),the difference was statistically significant(P<0.05).Conclusions IAP monitoring,as an emergency means of monitoring the efficacy of early EN in AP patients,has the advantages of simplicity,effic

关 键 词：急诊 腹内压监测 早期肠内营养 急性胰腺炎 空肠管 

分 类 号：R576[医药卫生—消化系统]