序贯性早期肠内营养在中度重症急性胰腺炎患者治疗中的作用

目的 研究对中度重症急性胰腺炎（MSAP）患者应用序贯性早期肠内营养（SEEN）支持疗法的临床疗效。方法 将2018年5月~2019年7月在安徽医科大学附属安庆医院普外科住院的67例符合条件的患者随机分为序贯性早期肠内营养组33例（A组）和早期肠内营养组34例（B组）。A组给予序贯性早期肠内营养支持，B组给予早期肠内营养支持。比较两组前白蛋白（PAB）、白蛋白（ALB）、淋巴细胞（CD3+、CD4+）、降钙素原（PCT）、白细胞（WBC）、C反应蛋白（CRP）、肿瘤坏死因子α（TNF-α）、白介素6（IL-6）、胃肠道不耐受情况及住院天数。结果 入院第1天，两组PAB、ALB、CD3+、CD4+、PCT、WBC、CRP、TNF-α、IL-6比较，差异无统计学意义（P＞0.05）；第3天，A组PCT、WBC、CRP、TNF-α、IL-6均低于B组，而CD3+、CD4+、PAB、ALB均高于B组，但差异无统计学意义（P＞0.05）；第7、11天，A组PCT、WBC、CRP、TNF-α、IL-6均低于B组，而CD3+、CD4+、PAB、ALB均高于B组（P＜0.05）；A组患者胃肠道不耐受发生率及住院天数均少于B组（P＜0.05）。结论 对MSAP患者行序贯性早期肠内营养支持治疗较早期肠内营养支持更有助于降低胃肠道不耐受的发生率，促进蛋白质合成，改善全身炎症反应和免疫功能低下状态，减少住院的天数。

The Role of Sequential Early Enteral Nutrition in the Treatment of Patients with Moderate Severe Acute Pancreatitis

Objective To investigate the clinical efficacy of sequential early enteral nutrition (SEEN) supportive therapy in patients with moderate severe acute pancreatitis (MSAP). Methods From May 2018 to July 2019, 67 eligible patients admitted to the Department of General Surgery, Anqing Hospital of Anhui Medical University were randomly divided into sequential early enteral nutrition group (33 groups) (group A) and early enteral nutrition. Group 34 cases (group B). Group A was given sequential early enteral nutrition support, and group B was given early enteral nutrition support. Comparison of two groups of prealbumin (PAB), albumin (ALB), lymphocytes (CD3+, CD4+), procalcitonin (PCT), white blood cells (WBC), C-reactive protein (CRP), tumor necrosis factor alpha (TNF) -α), interleukin-6 (IL-6), gastrointestinal intolerance, and length of hospital stay. Results On the first day of admission, there was no significant difference in PAB, ALB, CD3+, CD4+, PCT, WBC, CRP, TNF-α, IL-6 between the two groups (P>0.05). On the third day, PCT, WBC CRP, TNF-α, and IL-6 in group A were lower than group B, and CD3+, CD4+, PAB, and ALB were higher than group B, but the difference was not statistically significant (P>0.05).On days 7 and 11, PCT, WBC, CRP, TNF-α, and IL-6 in group A were lower than group B, while CD3+, CD4+, PAB, and ALB were higher than group B(P<0.05). The incidence of gastrointestinal intolerance and hospitalization days in group A were lower than those in group B(P<0.05). Conclusion Sequential early enteral nutrition support for MSAP patients is more helpful than early enteral nutrition support to reduce the incidence of gastrointestinal intolerance, promote protein synthesis, improve systemic inflammatory response and immune dysfunction, and reduce The number of days of hospitalization.