摘要
目的研究早期肠内营养支持对重症急性胰腺炎(SAP)患者炎性反应及营养状态的影响。方法选取2011年8月至2016年8月运城市中心医院收治的SAP患者182例,采用随机数字表法分为研究组与对照组,每组91例。两组均给予SAP常规治疗,对照组患者同时给予肠外营养支持,研究组患者则予以早期肠内营养支持,两组均连续营养支持2周。比较两组急性生理与慢性健康评分Ⅱ(APACHEⅡ)、肠功能恢复时间、全身炎症反应综合征(SIRS)改善时间以及住院时间,并比较治疗前、后各项血清炎性细胞因子水平、营养状态情况、多器官功能衰竭(MODS)发生率及病死率。结果治疗后研究组APACHEⅡ评分、肠功能恢复时间、SIRS改善时间以及住院时间分别为(6.14±1.20)分、(3.48±0.16)d、(4.31±2.02)d、(23.38±10.27)d,均明显低于对照组的(7.88±2.04)分、(6.21±1.33)d、(8.77±2.11)d、(29.46±11.31)d(t=4.595、19.441、14.601、18.797,均P<0.05)。治疗后研究组血清白细胞介素-6(IL-6)、白细胞介素-8(IL-8)以及肿瘤坏死因子-α(TNF-α)水平分别为(11.20±3.68)ng/L、(94.33±48.19)ng/L、(103.55±55.87)ng/L,均明显低于对照组的(22.47±9.84)ng/L、(240.72±78.85)ng/L、(245.62±105.48)ng/L(t=15.233、85.112、73.354,均P<0.05),且两组患者血清IL-6、IL-8及TNF-α均较治疗前显著降低(t=10.753、63.128、55.372、24.725、102.337、88.567,均P<0.05)。治疗后研究组血清白蛋白、血清前白蛋白水平分别为(41.24±6.25)g/L、(285.21±91.34)mg/L,均明显高于对照组的(37.15±5.71)g/L、(233.87±83.56)mg/L(t=8.609、58.956,均P<0.05),且两组患者血清白蛋白、前白蛋白均较治疗前明显升高(t=5.773、78.521、12.821、92.420,均P<0.05)。研究组并发症发生率、病死率分别为39.56%、14.29%,均明显低于对照组的60.44%、30.77%,差异均有统计学意义(χ^2=7.934、7.084,均P<0.05)。结论早期肠内营养支持治疗SAP效果明显,可有效减轻患者炎性反应,改善营养状态,且安全性较好,值得临床推广应用。
Objective To study the effect of early enteral nutrition support on inflammatory reaction and nutritional status in patients with severe acute pancreatitis(SAP). Methods From August 2011 to August 2016,182 patients with SAP in Yuncheng Central Hospital were selected.The patients were divided into study group and control group according to random number table method,with 91 cases in each group.The two groups were given routine treatment of SAP,the control group was given parenteral nutrition support,the study group was given early enteral nutrition support,the two groups were given continuous nutritional support for 2 weeks.The acute physiology and chronic health score Ⅱ(APACHE Ⅱ),intestinal function recovery time,systemic inflammatory response syndrome(SIRS) improvement time and hospital stay were compared between the two groups.The levels of serum inflammatory cytokines,nutritional status,the incidence of multiple organ failure(MODS) and mortality were compared before and after treatment. Results The APACHE Ⅱ,intestinal function recovery time,SIRS improvement time and hospital stay in the study group after treatment were (6.14±1.20)points,(3.48±0.16)d,(4.31±2.02)d,(23.38±10.2)d,which were significantly lower than those in the control group[(7.88±2.04)points,(6.21±1.33)d,(8.77±2.11)d,(29.46±11.31)d](t=4.595,19.441,14.601,18.797,all P<0.05).The serum levels of interleukin-6(IL-6),interleukin-8(IL-8) and tumor necrosis factor-α(TNF-α) in the study group after treatment were (11.20±3.68)ng/L,(94.33±48.19)ng/L,(103.55±55.87)ng/L,which were significantly lower than those in the control group[(22.47±9.84)ng/L,(240.72±78.85)ng/L,(245.62±105.48)ng/L](t=15.233,85.112,73.354,all P<0.05).The serum levels of IL-6,IL-8 and TNF-α in two groups were significantly lower than before treatment(t=10.753,63.128,55.372,24.725,102.337,88.567,all P<0.05).The serum levels of albumin,prealbumin in the study group after treatment were (41.24±6.25)g/L,(285.21±91.34)mg/L,which were significantly higher than those in the control group[(37.15±5.71)g/L,(233.87±83.56)mg/L](t=8.609,58.956,all P<0.05).The serum albumin and prealbumin in the two groups were significantly higher than those before treatment(t=5.773,78.521,12.821,92.420,all P<0.05).The incidence rate of complications and mortality in the study group were 39.56% and 14.29%,which were significantly lower than those in the control group(60.44%,30.77%),and the difference was statistically significant(χ2=7.934,7.084,all P<0.05). Conclusion The effect of early enteral nutrition support in patients with SAP is obvious,can effectively reduce the inflammatory response of patients and improve nutritional status,has good safety,which is worthy of clinical application.
作者
龙建
Long Jian(Department of ICU,Yuncheng Central Hospital,Yuncheng,Shanxi,044000,China)
出处
《中国基层医药》
CAS
2018年第24期3197-3201,共5页
Chinese Journal of Primary Medicine and Pharmacy
关键词
胰腺炎
急性病
重症监护
肠道营养
胃肠外营养
炎症趋化因子类
营养状态
影响
Pancreatitis
Acute disease
Intensive care
Enteral nutrition
Parenteral nutrition
Chemokines
Nutritional status
Influence
