重症急性胰腺炎早期肠内营养支持

目的 探讨早期肠内营养在重症急性胰腺炎（SAP）治疗中的安全性和有效性。方法回顾性分析71例SAP患者临床资料，经综合治疗观察患者血清白蛋白、前白蛋白、TNF-α、CD4／CD8、IgG水平。随机分为肠内营养组（EN组，36例）和全肠外营养组（TPN组，35例）。结果 EN组治疗后14d患者血清CD4/CD8及IgG水平比TPN组明显升高（P〈0．05）；EN组治疗后7、14d时TNF-α水平与治疗前比较明显下降（P〈0．05），且与TPN组比较明显减少（P〈0．05）；EN组治疗后血清前白蛋白水平较治疗前明显增高（P〈0．05），且与TPN组比较亦有显著性增高（P〈0．05）。结论早期肠内营养对SAP治疗是安全、有效的，可提高血清前白蛋白水平，改善其营养状况，增强肠道黏膜屏障，抑制炎性因子释放，增强患者的免疫功能，改善SAP的预后。

Validity of early enteral nutrition on treating acute severe pancreatitis

Objective To appraise the safety and validity of early enteral nutrition on the course on treating severe acute pancreatitis（SAP）. Methods The clinical data of 71 patients with SAP were analyzed retrospectively. The album, prealbumin, TNF- α, CD,/CDs, IgG were observed. All the patients were randomly divided into two groups： enteral nutrition （EN） group for 36 patients and total parenteral nutrition （TPN）group for 35 patients. Results Fourteen days after treatment, CD4 / CDs and IgG in EN group were significantly increased than those in TPN group （P 〈 0.05 ）, and prealbumin level in EN group significantly elevated （P 〈 0.05 ）and was higher than that in TPN group（P 〈 0.05 ）. After treatment, TNF- α level in EN group significantly depressed（P 〈 0.05 ）and was lower than that in TPN group（P 〈 0.05 ） .Conclusion Early enteral nutrition is safe and valid, and can promote albumin synthesis and proalbumin levels to improve their nutrition in patients with SAP, and may build-up the barrier of enteric mucosa to prevent bacterial shift, reduce systemic inflammatory reaction and improve its prognosis.