经皮内镜空肠造瘘术置管行早期肠内营养对重症急性胰腺炎的疗效

目的探讨经皮内镜空肠造瘘(PEG/J)术置管行早期肠内营养(EN)对重症急性胰腺炎(SAP)的治疗效果。方法回顾性分析了90例SAP患者的治疗情况,其中45例行PEG/J术置管早期肠内营养治疗(PEG/J组),45例行常规治疗(对照组)。90例患者于入院后1、12和18 d分别采集空腹外周静脉血,用酶联免疫吸附法测定白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α);三肽偶氮显色法测定内毒素含量,异硫氰酸荧光素(FITC)标记间接免疫荧光染色法测定CD4/CD8。结果入院后12和18 d PEG/J组患者血浆中IL-6、TNF-α及内毒素含量显著低于对照组(P<0.01),而CD4/CD8比值高于对照组(P<0.01),入院1 d PEG/J组IL-6、TNF-α、内毒素及CD4/CD8比值与对照组比较差异均无统计学意义(P>0.05)。对照组平均13.5 d体温恢复正常;并发上消化道出血2例,假性囊肿形成4例,二重感染2例;平均住院时间为33.5 d。PEG/J组平均10.5 d体温恢复正常;无并发上消化道出血及二重感染的病例,并发假性囊肿形成2例;平均住院时间为28 d。结论 PEG/J术置管行早期EN治疗SAP,疗效满意。

Clinical Effect of Early Enteral Nutrition in Severe Acute Pancreatitis by Percutaneous Endoscopic Gastrostomy/Jejunostomy

Objective To explore the clinical value of early enteral nutrition in severe acute pancreatitis(SAP) by percutaneous endoscopic gastrostomy/jejunostomy(PEG/J).Methods Treatment condition of nighty patients with SAP were retrospectively analysed.The 90 patients were collected peripheral venous blood respectively on 1,12,and 18 d after admission to hospital.Forty-five of them were in PEG/J group,the others were in control group.Serum IL-6,TNF-α and endotoxin were detected by enzyme-linked immunosorbent assay(ELISA),CD4/CD8 was determinated by indirect immunofluorescence staining method(FITC-labeled).Results On 12 d and 18 d,the levels of serum IL-6,TNF-α,and endotoxin in PEG/J group were lower than those in control group(P<0.01).The CD4/CD8was significantly higher than that in control group(P<0.01).In control group,2 cases complicated upper gastrointestinal haemorrhage,4 cases complicated pancreatic pseudocysts,and 2 cases complicated double infection,the temperature became normal after about 13.5 d.In PEG/J group,there were not upper gastrointestinal haemorrhage and double infection,but 2 cases also complicated pancreatic pseudocysts,the temperature became normal after about 10.5 d.Conclusion The clinical effectiveness of early enteral nutrition in SAP by PEG/J is satisfactory.