不同时机的早期鼻-空肠内营养支持对重症急性胰腺炎患者的影响

目的 探讨重症急性胰腺炎(SAP)患者早期鼻-空肠内营养(EN)支持的时机及其可行性和安全性.方法 收集72例SAP患者,按数字表法随机分为观察组和对照组.观察组实施EN的时机为患者循环相对稳定,腹胀减轻,闻及肠鸣音;对照组实施EN的时机为生命体征稳定,肠蠕动恢复,无腹胀,有排气及饥饿感.比较两组患者分泌物培养情况、住院时间、总住院费用等的差异.结果 两组患者咽拭子、痰、中段尿培养阳性率无显著差异,但观察组粪培养阳性率为5.6%,明显低于对照组的33.3%(P＜0.01).观察组的住院天数、住院总费用分别为(26.0±15.2)d和(78 910±77 734)元,明显低于对照组的(32.9±22.3)d和(149 528±145 936)元(P＜0.05).结论 适当提前实施EN是安全可行的,对缩短病程、降低住院费用等方面均有积极的作用.

Effects of different timing of early naso-jejunal nutritional support on severe acute pancreatitis patient's prognosis

Objective To investigate the timing of early naso-jejunum nutritional support on severe acute pancreatitis(SAP) patients and its feasibility and safety. Methods 72 patients with SAP were enrolled and randomized into experiment group and control group according to random number. EN (enteral nutrition) was administrated in the experiment group when the patients' circulation were relatively stable, abdominal distention decreased and the bowel sound could be heard; while EN was administrated in the control group when the patients' vital signs were stable, and peristalsis recovered with exhaust and sense of hunger, without obvious abdominal distention. The cultivation of secretions, hospital stay and overall cost of hospitalization were evaluated in the two groups of patients. Results The throat swabs, sputum culture, mid-portion urine culture of the two group were not significantly different. But the fecal culture in the experiment group was significantly lower than those of the control group (5.6% vs. 33.3%, P ＜ 0. 01); the hospital stay and overall cost of hospitalization in the experiment group was (26.0 ± 15.2)d and (78910 ± 77734)Yuan, which were significantly lower than those in the control group [(32.9 ± 22.3) d and (149528 ± 145936) Yuan, P ＜0.05]. Conclusions Appropriately bringing forward EN is safe and feasible, which can shorten clinical course and reduce the cost of hospitalization.