早期胃镜下鼻空肠管置人肠内营养对急性重症胰腺炎内毒素血症的影响

目的观察早期胃镜下置人鼻空肠管行肠内营养对急性重症胰腺炎（SAP）肠源性内毒素血症的治疗作用。方法43例符合条件的SAP患者随机分为两组，肠内营养组24例：早期行胃镜下鼻空肠管置人行肠内营养治疗；全胃肠外营养组19例：行全肠外营养治疗。观察比较患者的腹痛、腹胀时间、血浆内毒素的改变，同时了解血浆白蛋白、淀粉酶恢复时间以及并发症发生率。结果肠内营养组患者腹痛、腹胀缓解时间分别为（3．3±2．2）、（7．6±3．2）d，明显优于全肠外营养组分别为（7．1±3．8）、（13．3±4．9）d，F值分别为48．038、63．567，P均〈0．01]，发生胃肠道出血0例、肺部及肠道感染1例、高血糖2例、胰腺囊肿1例，并发症亦少于全肠外营养组（分别为5、10、8、6例，X2值分别为7．147、13．084、6．777、5．847，P〈0．05或P〈0．001）。血浆内毒素在肠内营养组中下降较早、较快，治疗后14d降至（0．19±0．11）EU／ml，明显低于全肠外营养组的（0．85±0．28）EU／ml，两组间比较差异有统计学意义（t=10．456，P〈0．001）。肠内营养组血浆淀粉酶治疗前及治疗后7、14d分别为（1623±479）、（547±322）、（179±106）U／L，全胃肠外营养组分别为（1467±589）、（789±503）、（233±156）U／L，两组血浆淀粉酶较治疗初期均显著降低，两组间比较在治疗后7、14d时差异无统计学意义（t值分别为3．117、1．889，P均〉0．05）。两组血浆白蛋白治疗后均升高，但两组间差异无统计学意义（P〉0．05）。结论胃镜下鼻空肠管置入早期肠内营养治疗能显著改善SAP患者的症状、减少并发症、保护肠黏膜，有利于SAP肠源性内毒素血症的治疗。

Effects of enteral nutrition by gastroscope-guided naso-jejunal feeding tube placement on acute severe pancreatitis endotoxemia

Objective To investigate the therapeutic effects of early enteral nutrition by gastroscope- guided naso-jejunal feeding tube placement on the intestinal endotoxemia of patient with severe acute pancreatitis （SAP）. Methods Fourty-three patients were randomized into two groups： patients receiving early enteral nutrition （EN） by gastroscope-guided naso-jejunal feeding tube placement （24 cases） and those receiving total parenteral nutrition （.TPN） （ 19 cases）. The serum endotoxin（ ET）, albumin （ALB） and amylase （AMY） levels were measured. Abdominal distension and other complications were observed in the two groups. Results The abdominal pain and distension relief time, intestinal bleeding, infectious complications of EN group were significantly improved compared with that of TPN group （P 〈0. 01或 P 〈0. 05 ± P 〈0. 001 ）. The serum ET levels of EN group was much lower （ 0. 19 ± 0. 11 ] EU/ml） than that of TPN group （ 0. 85± 0. 28 ] EU/ml） on day 14 post-treatment （t = 10. 456,P 〈0. 001 ）. The serum AMY levels were decreased significantly in two groups after treatment, and the difference between two groups was not significant （t =3.117, t = 1. 889, P 〉 0. 05）. The serum ALB recovery of two groups was not significantly different （ P 〉 0.05 ） . Conclusion Gastroscope-guided Naso-jejunal feeding tube placement for early enteral nutrition can protect intestinal mucosa, reduce complications, alleviate symptoms of patients with SAP, which are benefitial factors for the treatment of intestinal endotoxemia in patients with SAP.