肠内营养支持在急性重症胰腺炎病人的应用研究

目的 观察肠内营养对急性重症胰腺炎病人的作用，研究其应用时机、途径及肠内营养制剂的选择。方法 按亚特兰大（Atlanta）国际会议的诊断标准，收集急性重症胰腺炎病人40例，随机分成两组。分别给予全肠内营养（TEN）和全肠外营养（TPN）支持。两组总热量的供给、开始时间的支持和天数相同。在TEN组采用荷兰NUTRICIA公司提供的螺旋形鼻肠管CH10。导管的尖端应达到Treitz韧带以下。在TEN组，肠内营养制剂能全力（Nutrison Fibre)、百普素（Pepti-2000)和爱伦定期复查CT。所得数据采用SPSS 8．0软件进行统计分析，根据情况使用x^2检验或t检验。结果 血清白蛋白浓度两组升高，两组比较有显性差异。肝酶谱的恢复TEN组明显优于TPN组。淀粉酥的下降和CT影像两组无明显差异。在TEN组中，接受能力全力支持的病人胃肠道和代谢方面的并发症较少，病人容易接受。结论 急性重症胰腺炎的病人早期肠内营养支持不仅重要，而且可行。肠内营养较肠外营养在增加快速反应蛋白的合成、改善肝功能和免疫功能、缓解炎性反应、增强肠道粘膜屏障功能以及减少TPN并发症等方面明显优于肠外营养。

The application and research of enteral nutritional support in patients with acute severe pancreatitis

Objective To observe the effect of enteral nutrition(EN) in thetreatment of patients with acute severe pancreatitis and to study its applying time,ways as well as the choice of EN preparation. Methods 40 cases of acute severe pancreatitis were collected according to diagnostic standard in the Atlanta international meeting,these patients were divided into two groups on the basis of stochastics in which was given TEN and TPN support separately.The supply of total heat,the time of beginning and supporting days are same in this two groups.Catheter from nose to intestine which was provided by UNTRICIA copany has been applied in the TEN group,the tip of catheter should be up to below of Treitz ligament.The use of EN preparation-Nutrison Fibre,Pepti-2000 and Elental were occupied 1/3 respectively in TEN group.The serum albumin,prealbumin,transferring,IgG,IgM,IgA,liver function and blood as well as urinary amylase in all patients were monitored,meanwhile CT follow-up examination was taken regularly.The data from above methods were proceeded to count and to analyze under SPSS 8.0 computer soft,at same time,the data were also tested by χ２ analysis TEST or T analysis. Results The concentration of serum albumin in patients of two groups apparently was increased before obtaining the EN support,but there is not apparently difference between two groups.The level of albumin()in TEN group was clearly increased compare with that in TPN group after the ten days getting EN support,the apparently differences were seen through comparing two groups's patients.The recovery of liver function in TEN group were obvious more than that in TPN group.There is no obvious difference in the aspect of amylase'dropping and CT pictures in two groups.For these patients getting full EN support,the opportunity affecting complication of stomach and intestinal tract as well as metabolism were less,and the patient is easy to accept it. Conclusions Early EN support in patients with acute severe pancreatitis not only is important but also feasible.EN has apparent advantage compare with PN in the aspect of increasing the synthesis of rapidly reactive albumen,improving liver function and immunity function,mitigating the acute reaction and enhancing the function of intestinal tract's mucous as barrier,reducing TPN complication.