重症急性胰腺炎患者术后行早期肠内营养联合肠外营养与单独全肠外营养支持的效果比较  

Comparative study on the effect of early enteral nutrition combined with parenteral nutrition versus total parenteral nutrition support alone after surgery for severe acute pancreatitis

作　　者：赵圆圆 范静雯 崔胤 宋斌[1] Zhao Yuanyuan;Fan Jingwen;Cui Yin;Song Bin(Department of Hepatobiliary and Pancreatic Surgery I,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院肝胆胰外一科,郑州450000

出　　处：《中国实用医刊》2024年第2期86-89,共4页Chinese Journal of Practical Medicine

摘　　要：目的比较早期肠内营养联合肠外营养与单独全肠外营养支持在重症急性胰腺炎(SAP)术后辅助治疗中的效果。方法抽取2021年3月至2023年1月郑州大学第一附属医院肝胆胰外一科收治的SAP手术患者101例为研究对象,按照随机数字表法分为对照组(50例)与观察组(51例)。对照组术后行全肠外营养支持,观察组采用早期肠内营养联合肠外营养支持。比较两组治疗前后营养指标(总蛋白、白蛋白、前白蛋白)、细胞免疫水平(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、急性生理与慢性健康状况Ⅱ(APACHE-Ⅱ)评分。结果治疗7 d后,两组总蛋白、白蛋白、前白蛋白水平均高于治疗前,且观察组高于对照组(P<0.05)。治疗7 d后,两组CD4^(+)、CD4^(+)/CD8^(+)水平高于治疗前,CD8^(+)低于治疗前(P<0.05);治疗7 d后,观察组CD4^(+)、CD4^(+)/CD8^(+)水平高于对照组,CD8^(+)低于对照组(P<0.05)。治疗7 d后,两组APACHE-Ⅱ评分低于治疗前,且观察组低于对照组(P<0.05)。结论相较于单独全肠外营养,SAP术后行早期肠内营养联合肠外营养,患者营养状态与机体免疫功能改善更理想,继而有助于进一步减轻患者病情。Objective To compare the effect of early enteral nutrition combined with parenteral nutrition versus total parenteral nutrition support alone in the postoperative treatment of severe acute pancreatitis(SAP).Methods A total of 101 patients with SAP admitted to the Department of Hepatobiliary and Pancreatic Surgery I in the First Affiliated Hospital of Zhengzhou University from March 2021 to January 2023 were selected as the study subjects.And they were divided into control group(50 cases)and observation group(51 cases)by random number table method.The control group received postoperative total parenteral nutrition support,while the observation group received early enteral nutrition combined with parenteral nutrition support.The nutritional indicators(total protein,albumin,prealbumin),levels of cellular immune assessed by cluster of differentiation 4^(+)(CD4^(+)),cluster of differentiation 8^(+)(CD8^(+))and CD4^(+)/CD8^(+),and acute physiology and chronic health evaluation-Ⅱ(APACHE-Ⅱ)score were compared between the two groups before and after treatment.Results After 7 days of treatment,the levels of serum total protein,albumin and prealbumin of the two groups were higher than those before treatment,while the observation group had higher levels of serum total protein,albumin and prealbumin compared with the control group(P<0.05).After 7 days of treatment,the levels of CD4^(+)and CD4^(+)/CD8^(+)of the two groups increased,and the level of CD8^(+)of the two groups decreased compared with preoperative levels(P<0.05).After 7 days of treatment,the levels of CD4^(+)and CD4^(+)/CD8^(+)of the observation group were higher,and the level of CD8^(+)was lower,compared with the control group(P<0.05).After 7 days of treatment,the APACHE-Ⅱ score of the two groups were lower than those before treatment,moreover,the APACHE-Ⅱ score of the observation group was lower than that of the control group(P<0.05).Conclusions Compared with total parenteral nutrition support alone,the combination of early enteral nutrition and parentera

关 键 词：胰腺炎 急性 肠内营养 肠外营养 营养指标 细胞免疫 

分 类 号：R657.51[医药卫生—外科学] R459.3[医药卫生—临床医学]