| 早期肠内营养和全胃肠外营养 治疗急性重症胰腺炎的疗效及预后比较 |
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| 引用本文： | 陈予. 早期肠内营养和全胃肠外营养 治疗急性重症胰腺炎的疗效及预后比较[J]. 蚌埠医学院学报, 2019, 44(2): 182-185. DOI: 10.13898/j.cnki.issn.1000-2200.2019.02.013 |
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| 作者姓名： | 陈予 |
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| 作者单位： | 川北医学院附属医院 消化内科,四川 南充,637000 |
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| 摘 要： | 目的比较早期肠内营养与全胃肠外营养治疗重症胰腺炎的临床疗效及预后。方法选取重症胰腺炎病人80例，随机分为对照组和观察组，各40例。对照组病人给予全胃肠外营养治疗，观察组病人给予早期肠内营养治疗。比较2组病人的血淀粉酶恢复时间、尿淀粉酶恢复时间、住院时间和血清总蛋白、白蛋白、尿素氮水平及血淋巴细胞百分比、相关炎性因子水平、内毒素水平、细胞免疫功能、APACHEⅡ评分。结果观察组血、尿淀粉酶恢复时间及住院时间均明显少于对照组（P < 0.01）。治疗后观察组病人的血清总蛋白、白蛋白、尿素氮水平及血淋巴细胞百分比均明显高于对照组（P < 0.01）。治疗后2组病人肿瘤坏死因子-α、白细胞介素（IL）-1β、IL-6、IL-8和内毒素水平均较治疗前降低（P < 0.05~P < 0.01）；且治疗后观察组病人的肿瘤坏死因子-α、IL-1β、IL-6、IL-8和内毒素水平均低于对照组（P < 0.05~P < 0.01）。治疗后2组病人的CD3+、CD4+和CD4+/CD8+均较治疗前明显提高（P < 0.01），而CD8+水平较治疗前降低（P < 0.05）；治疗后观察组病人的CD3+、CD4+和CD4+/CD8+均高于对照组（P < 0.05~P < 0.01），而CD8+水平则明显低于对照组（P < 0.01）。治疗后24、48、72 h，观察组APACHEⅡ评分均明显低于治疗前（P < 0.01），治疗后48、72 h均低于治疗后24 h（P < 0.05和P < 0.01），且观察组各时点APACHEⅡ评分均低于对照组（P < 0.05~P < 0.01）。结论早期肠内营养治疗可明显降低重症胰腺炎病人的炎性因子水平，提高免疫功能，改善病人预后。
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| 关 键 词： | 重症胰腺炎 早期肠内营养治疗 全胃肠外营养治疗 |
| 收稿时间： | 2016-10-11 |
Comparison of the clinical efficacy and prognosis between early enteral nutrition and total parenteral nutrition in the treatment of severe pancreatitis |
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| Affiliation: | Department of Gastroenterology, The Affiliated Hospital of Chuanbei Medical College, Nanchong Sichuan 637000, China |
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| Abstract: | ObjectiveTo compare the clinical efficacy and prognosis between early enteral nutrition and total parenteral nutrition in the treatment of severe acute pancreatitis.MethodsEighty patients with severe pancreatitis were randomly divided into the control group and observation group(40 cases each group).The control group was treated with total parenteral nutrition, and the observation group was treated with early enteral nutrition.The recovery time of hemodiastase and urine amylase levels, hospital stay, levels of total serum protein, albumin and urea nitrogen, percentage of blood lymphocyte, inflammatory factor level, cellular immune function and APACHEⅡ score between two groups were compared.ResultsThe recovery time of hemodiastase, recovery time of urine amylase and hospital stay in observation group after treatment were significantly shorter than those in control group(P < 0.01).The levels of total serum protein, albumin, urea nitrogen and percentage of blood lymphocyte in observation group after treatment were significantly higher than those in control group(P < 0.01).After treatment, the levels of TNF-α, IL-1β, IL-6, IL-8 and endotoxin in two groups significantly decreased compared with before treatment(P < 0.05 to P < 0.01), and the levels of TNF-α, IL-1β, IL-6, IL-8 and endotoxin in observation group were significantly lower than those in control group(P < 0.01).Compared with before treatment, the levels of CD3+, CD4+ and CD4+/CD8+ significantly increased(P < 0.01), and the level of CD8+ significantly decreased in two groups after treatment(P < 0.05).After treatment, the levels of CD3+, CD4+ and CD4+/CD8+ in observation group were significantly higher than those in control group(P < 0.01), and the level of CD8+ in observation group was significantly lower than that in control group(P < 0.01).The APACHEⅡ score in observation group after 24h, 48h and 72h of treatment was significantly lower than that before treatment(P < 0.01), the APACHEⅡ score in observation group after 48 h and 72h of treatment was significantly lower than that after 24h of treatment(P < 0.05 and P < 0.01), and the APACHEⅡ score in observation group at each time-point was significantly lower than that in control group(P < 0.05 to P < 0.01).ConclusionsEarly enteral nutrition in the treatment of severe pancreatitis can effectively reduce the inflammatory factor level, enhance cellular immune function, and improve prognosis of patients. |
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