早期通里攻下联合肠内营养治疗重症急性胰腺炎40例

目的:观察早期给予通里攻下联合肠内营养治疗急性重症胰腺炎的临床疗效。方法:将80例患者随机分为2组,每组40例。2组均予以急性重症胰腺炎基础治疗,对照组于入院第2天将肠内营养制剂自鼻肠管滴入,剂量为5 mL/kg,滴速为30 mL/h,1次/d。观察组于入院第2天先自鼻肠管滴入大承气汤煎剂,剂量为3 mL/kg,滴速为30 mL/h,1次/d;再于中药滴注2小时后将肠内营养制剂自鼻肠管滴入,剂量为5mL/kg,滴速为30 mL/h,1次/d。2组均于可经口饮食时结束上述治疗。观察2组入院后第1、3、7天外周血白细胞(WBC)计数,入院后第1、3天外周血C反应蛋白(CPR),入院第1、7天血浆内毒素,入院第1、7天血清降钙素原(PCT)及前白蛋白、白蛋白,以及肠源性感染发生率、外科手术干预率、死亡率、住院时间。结果:WBC、CRP、内毒素、PCT、前白蛋白、白蛋白等指标2组治疗后与治疗前比较,差异有统计学意义(P0.05);治疗后相同时点组间比较,差异也有统计学意义(P0.05)。观察组平均住院时间(40.02±5.22)天,发生肠源性感染2例(5.00%),死亡1例(2.50%),手术干预2例(5.00%);对照组平均住院时间(43.83±4.87)天,发生肠源性感染10例(25.00%),死亡2例(5.00%),手术干预5例(12.50%)。2组平均住院时间、肠源性感染率、死亡率、手术干预率比较,差异有统计学意义(P0.05)。结论:早期给予通里攻下联合肠内营养治疗能有效降低急性重症胰腺炎患者的肠源性感染发生率,改善患者短期内营养状态,并能减少患者住院时间。

Early Removing Stasis by Purgation Combined with Enteral Nutrition in Treatment for 40 Cases with Severe Acute Pancreatitis

Objective: To observe the clinical effect of early removing stasis by purgation combined with enteral nutrition in treatment of patients with severe acute pancreatitis. Methods: 80 patients were randomly divided into two groups, each group of 40 cases. The two groups were given basic treatment of severe acute pancreatitis. On the second day after admission, the control group was treated with the enteral nutrition preparation from nasointestinal tube infusion at a dose of 5 mL/kg, dropping speed of 30 mL/h, and once a day. At the same time, the observation group was treated with the Da Cheng Qi decotion preparation from nasointestinal tube infusion at a dose of 3 mL/kg, dropping speed of 30 mL/h, and once a day. Both groups finished their treatments when they can resume oral intake. These indicators of the two groups, such as the counting of white blood cell (WBC) in peripheral blood at day one, day three and day seven after admission, the C reactive protein (CPR) in peripheral blood at day one and three after admission, the plasma endotoxin levels at day one and day seven after admission, the serum procalcitonin (PCT), prealbumin and albumin at day first and day 7 after admission, and the incidence of intestinal infection, surgical intervention rate, mortality, length of stay were observed. Results: Compared with the indicators such as WBC, CRP, endotoxin, PCT, prealbumin, albumin of the two groups before and after treatment, the difference was statistically significant (P<0.05); Compared between groups at the same time point after treatment, the differences were statistically significant (P<0.05). The average length of stay in the observation group was (40.02±5.22) days, among which intestinal infection occurred in two cases (5.00%), the death of one case (2.50%), surgical intervention in two cases (5.00%); At the same time, the average length of stay in the control group was (43.83± 4.87) days, among which intestinal infection occurred in 10 cases (25.00% ), the death of two cases (5.00% ), surgical intervention in five cases (12.50% ). There was a significant difference between the two groups in average hospitalization time, intestinal infection rate, mortality rate and surgical intervention rate (P<0.05). Conclusion:Treatment of early removing stasis by purgation combined with enteral nutrition can effectively reduce the incidence of intestinal infection in patients with severe acute pancreatitis, improve the nutritional status of patients in the short term, and decrease the length of hospital stay.