重症急性胰腺炎应用肠内营养治疗时机的临床研究

目的观察重症急性胰腺炎不同时间开始进行肠内营养支持的临床效果,探讨重症急性胰腺炎肠内营养支持的最佳时机。方法 90例重症急性胰腺炎患者随机分为三组,治疗组1入院48～60h开始给予肠内营养治疗,治疗组2入院60～72h开始给予肠内营养治疗,对照组给予全胃肠外营养治疗。观察APACHE-Ⅱ评分、腹部CT评分、肝功能、肾功能、血脂全套、C-反应蛋白、肿瘤坏死因子、腹痛腹胀缓解时间、血淀粉酶恢复正常时间、肠道功能恢复时间、住院时间、从肠外营养＋肠内营养过渡到肠内营养所需的时间、发生不良反应、死亡、继发感染、继发MODS以及外科干预等情况。结果治疗后7d治疗组1APACHE-Ⅱ评分的下降程度明显大于治疗组2（P〈0.05）;治疗组1治疗后7d各项生化指标均明显优于治疗组2（P〈0.05）;治疗组1肠道功能恢复的时间和住院时间明显少于治疗组2（P〈0.05）;治疗组1的过渡时间明显短于治疗组2（P〈0.05）;治疗组1有4例患者出现轻度腹痛腹胀,1例继发MODS,治疗组2有1例出现轻度腹痛腹胀,1例继发感染,对照组有9例继发感染,8例继发MODS,2例死亡,4例外科干预。结论早期应用肠内营养能促进肠黏膜功能恢复,明显缩短重症急性胰腺炎患者感染的病程,控制炎症反应,改善病情预后,只要患者病情允许可尽早给予肠内营养支持。

THE STUDY ON THE OPTIMAL TIME FOR APPLYING ENTERAL NUTRITION FOR SEVERE ACUTE PANCREATITIS

Objective To observe the clinical effect of starting support in different time on patients of severe acute pancreatitis and to explore the optimal timing for providing enteral nutrition support to the patients.Methods A total of 90 patients with severe acute pancreatitis were selected and randomly divided into three groups.Patients in the treatment group A were provided with the enteral nutrition support 48～60h after hospitalization,patients in treatment group B60～72h after hospitalization,whereas the patients in control group were given the treatment of total parenteral nutrition.The relative data were recorded included APACHE-II score,abdominal CT score,liver function,renal function,lipid,C-reactive protein,tumor necrosis factor,abdominal pain relief time,recovery time of blood amylase,intestinal function recovery time,hospitalization time,the needed time of transition from parenteral and enteral nutrition to enteral nutrition,adverse reactions,death,secondary infection,secondary MODS and surgical intervention,etc.Results Seven days after treatment,the APACHE-Ⅱscore of the treatment group A decreased significantly more than that of the treatment group B,（P〈0.05）.The biochemical indexes of treatment group A were significantly better than the treatment group B.The intestinal function recovery time and hospital stay time of treatment group A were significantly less than those of the treatment group B（P〈0.05）.The transitional time of group A was markedly shorter than that of treatment group B（P〈0.05）.Four patients in treatment group A experienced mild abdominal pain,one case of secondary MODS,two cases in treatment group B went through mild abdominal pain,one case of secondary MODS,with nine cases of secondary infection,eight cases of secondary MODS,two cases of death and four cases of surgical intervention in control group.Conclusions Early application of enteral nutrition can promote the recovery of intestinal function,shorten the treatment course of infection in patients with severe acute