早期肠内营养和微生态免疫肠内营养对重症急性胰腺炎患者肾损伤的预防效果及影响因素  

Analysis of preventive effect and influencing factors of early enteral nutrition and microecological immune enteral nutrition on renal injury in patients with severe acute pancreatitis

作　　者：汪纾羽 焦茹 石运涛[1] Wang Shuyu;Jiao Ru;Shi Yuntao(Department of Gastroenterology,Huai'an First People's Hospital,Huai'an 223300,China)

机构地区：[1]淮安市第一人民医院消化内科,江苏省223300

出　　处：《中华消化病与影像杂志（电子版）》2024年第2期132-136,共5页Chinese Journal of Digestion and Medical Imageology(Electronic Edition)

摘　　要：目的分析早期肠内营养和微生态免疫肠内营养对重症急性胰腺炎(SAP)患者肾损伤的预防效果,探讨影响患者肾损伤的风险因素。方法选取2020年1月至2022年12月淮安市第一人民医院收治的296例SAP患者,随机分为联合组(n=148)、对照组(n=148),2组均接受常规治疗及早期肠内营养支持,联合组加用阶段性微生态免疫肠内营养支持。对比2组患者肾损伤发生情况,并比较发生、未发生肾损伤患者临床资料和营养支持方案,使用Logistic回归模型归纳与患者肾损伤相关的风险因素。结果2组干预7 d后总蛋白、白蛋白、前白蛋白、转铁蛋白均较干预前升高,联合组干预7 d后总蛋白、白蛋白、前白蛋白、转铁蛋白均高于对照组(P<0.05)。联合组肾损伤发生率为22.30%(33/148),较对照组的36.49%(54/148)更低,差异有统计学意义(χ^(2)=7.179,P<0.05)。多因素回归分析示,年龄、APACHEⅡ评分、C反应蛋白、胱抑素C升高,以及CT分级E级、合并糖尿病、机械通气、休克均为影响SAP患者发生肾损伤的独立危险因素,微生态免疫肠内营养为保护因素(P<0.05)。结论SAP患者营养状态普遍较差,且接受微生态免疫肠内营养后营养状态较单纯肠内营养支持改善更为明显,其肾损伤风险也随之下降,同时,SAP患者肾损伤的发生也与年龄、病情严重度、炎症反应严重程度、合并症等基线特征有关。Objective To analyze the preventive effects of early enteral nutrition and microecological immune enteral nutrition on renal injury in patients with severe acute pancreatitis(SAP),and to explore the risk factors affecting renal injury in patients.Methods A total of 296 patients with SAP admitted to Huai'an First People's Hospital from January 2020 to December 2022 were randomly divided into combined group(n=148)and control group(n=148).Both groups received routine treatment and early enteral nutrition support,while the combined group received staged microecological immune enteral nutrition support.The incidence of renal injury was compared between the two groups,and the clinical data and nutritional support programs of patients with and without renal injury were compared.Logistic regression model was used to summarize the risk factors related to renal injury.Results After 7 days of intervention,the total protein,albumin,prealbumin and transferrin in the two groups were higher than those before intervention,while those in the combined group were higher than those in the control group after 7 days of intervention(P<0.05).The incidence of renal injury in the combined group was 22.30%(33/148),which was lower than that in the control group(36.49%,54/148),with statistically significant difference(χ^(2)=7.179,P<0.05).Multivariate regression analysis showed that age,APACHEⅡscore,C-reactive protein and cystatin C,as well as CT grade E,diabetes,mechanical ventilation and shock were all independent risk factors for renal injury in SAP patients,and microecological immune enteral nutrition was the protective factor(P<0.05).Conclusion The nutritional status of SAP patients is generally poor,and the nutritional status is improved more obviously after receiving microecological immune enteral nutrition support than simple enteral nutrition support,and the risk of renal injury is also reduced.At the same time,the occurrence of renal injury in SAP patients is also related to baseline characteristics such as age,severity of illne

关 键 词：重症急性胰腺炎 肠内营养 微生态免疫 肾损伤 影响因素 

分 类 号：R576[医药卫生—消化系统]