SAP患者鼻胃管肠内营养时机选择及肠源性感染指标表达水平的变化分析  

Analysis of the enteral nutrition timing in nasogastric tube and the expression level of intestinal infection indexes in severe acute pancreatitis patients

作　　者：杨丽晖[1] 徐凤娟 靳晓倩 王刚[4] 王欣彤[1] Yang Lihui;Xu Fengjuan;Jin Xiaoqian;Wang Gang;Wang Xintong(Department of Nursing,the Second Affiliated Hospital of Xingtai Medical College,Xingtai 054000,Hebei,China;Department of Respiratory and Critical Care Medicine,the Second Affiliated Hospital of Xingtai Medical College,Xingtai 054000,Hebei,China;Department of Neurosurgery,the Second Affiliated Hospital of Xingtai Medical College,Xingtai 054000,Hebei,China;Department of Foundation,Xingtai Medical College,Xingtai 054000,Hebei,China)

机构地区：[1]邢台医学高等专科学校第二附属医院护理部,河北邢台054000 [2]邢台医学高等专科学校第二附属医院呼吸与危重症医学科,河北邢台054000 [3]邢台医学高等专科学校第二附属医院神经外科,河北邢台054000 [4]邢台医学高等专科学校基础部,河北邢台054000

出　　处：《中国中西医结合急救杂志》2023年第2期199-203,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：河北省邢台市重点研发计划(2022ZC186)。

摘　　要：目的 观察重症急性胰腺炎(SAP)患者给予鼻胃管肠内营养时机的选择及肠源性感染指标表达水平的变化.方法 选择2017年5月至2020年12月在邢台医学高等专科学校第二附属医院接受治疗的90例SAP患者作为研究对象.按随机数字表法将患者分为早期肠内营养组(45 例)和常规肠内营养组(45 例),于入院 48h内和 48h后给予鼻胃管肠内营养.比较两组治疗效果、治疗前和治疗 14d后的营养状况及肠源性感染指标的差异,并观察并发症发生情况.结果 与常规肠内营养组比较,治疗后早期肠内营养组计算机断层扫描严重指数(CTSI)评分(分:3.41±1.22 比 3.94±1.20)、Ranson评分(分:3.37±1.03 比 3.82±0.97)、急性生理学与慢性健康状况评分Ⅱ[APACHEⅡ(分):7.54±3.62 比 10.08±3.52]、C-反应蛋白[CRP(mg/L):5.88±1.03比 17.49±3.64]、降钙素原[PCT(μg/L):1.68±0.42 比 5.57±1.26]、白细胞计数[WBC(×10^(9)/L):9.31±1.24 比12.98±2.01]和内毒素(kU/L:0.28±0.08 比 0.66±0.21)均明显降低(均P<0.05),重症监护病房(ICU)住院时间(d:9.63±4.76 比 14.82±4.61)、住院时间(d:21.46±5.18 比 26.80±5.35)均明显缩短(均P<0.05),住院费用明显减少(万元:11.87±1.92 比13.59±2.47,P<0.05),多器官功能障碍综合征(MODS:13.33%比 42.22%)、肺炎(20.00%比 44.44%)、呼吸衰竭(8.89%比 33.33%)和胰腺感染(11.11%比 35.56%)等并发症发生率亦均明显降低(均P<0.05);前白蛋白(g/L:36.10±3.46 比 32.19±3.17,P<0.05)、白蛋白(g/L:0.29±0.04 比0.25±0.05,P<0.05)水平均明显升高.结论 对SAP患者早期给予肠内营养能有效改善营养状况,降低肠源性感染指标水平,并减少MODS、胰腺感染、呼吸衰竭、肺炎等的发生率,从而能促进患者恢复,缩短其ICU住院时间和住院时间,减少住院费用;加之鼻胃管肠内营养操作简单方便,置管费用低,患者耐受性高,可在临床推广应用.Objective To observe the timing of enteral nutrition with nasogastric tube and the changes in the expression level of intestinal infection indicators in patients with severe acute pancreatitis(SAP).Methods A total of 90 SAP patients who received treatment at the Second Affiliated Hospital of Xingtai Medical College from May 2017 to December 2020 were selected as the research subjects.Patients were divided into early enteral nutrition group(45 cases)and routine enteral nutrition group(45 cases)using a random number table method.Nasogastric tube enteral nutrition was administered within 48 hours of admission and 48 hours after admission.The differences in treatment efficacy,nutritional status,and intestinal infection indicators between the two groups before and after 14 days of treatment were compared,and the occurrence of complications was observed.Results Compared with the routine enteral nutrition group,the computed tomography severity index(CTSI)score(3.41±1.22 vs.3.94±1.20),Ranson score(3.37±1.03 vs.3.82±0.97),acute physiology and chronic health evaluation II(APACHE II:7.54±3.62 vs.10.08±3.52),C-reactive protein[CRP(mg/L):5.88±1.03 vs.17.49±3.64],procalcitonin PCT(μg/L):1.68±0.42 vs.5.57±1.26,WBC(×10^(9)/L):9.31±1.24 vs.12.98±2.01)and endotoxin(kU/L:0.28±0.08 vs.0.66±0.21)were significantly reduced in the early enteral nutrition group(all P<0.05),the time spent in intensive care uni [ICU(days):9.63±4.76 vs.14.82±4.61)and hospitalization time(days:21.46±5.18 vs.26.80±5.35)were significantly shortened(both P<0.05),hospitalization expenses were significantly reduced(ten thousand yuan:11.87±1.92 vs.13.59±2.47,P<0.05),and the incidence of complications such as multiple organ dysfunction syndrome(MODS:13.33%vs.42.22%),pneumonia(20.00%vs.44.44%),respiratory failure(8.89%vs.33.33%),and pancreatic infection(11.11%vs.35.56%)were also significantly reduced(all P<0.05),pre albumin(g/L:36.10±3.46 vs.32.19±3.17,P<0.05)and albumin(g/L:0.29±0.04 vs.0.25±0.05,P<0.05)were significantly increased.Conclu

关 键 词：重症急性胰腺炎 鼻胃管肠内营养 治疗时机 疗效 肠源性感染 

分 类 号：R576[医药卫生—消化系统] R459.7[医药卫生—内科学]