PEG/J技术与鼻空肠管在重症急性胰腺炎患者营养支持治疗中的比较

目的:比较经皮内镜引导下胃空肠造瘘(PEG/J)术置管与鼻空肠管行肠内营养(EN)治疗重症急性胰腺炎(SAP)的治疗效果。方法:回顾性分析61例SAP患者的治疗情况,其中15例采用PEG/J术置管行EN治疗(PEG/J组),46例行采用鼻空肠管行EN治疗(鼻空肠管组),比较两组之间的操作时间、患者恢复排便时间、患者血象降至正常所需时间、导管相关肺部感染率、营养管平均留置时间和患者自感舒适度。结果:PEG/J组的操作时间较长,但是恢复排便时间要快于鼻空肠管组,且血象降到正常所需的时间也明显比鼻空肠管组短(均P<0.05);PEG/J组要比鼻空肠管组的留管时间长,但是导管相关肺部感染率要明显低于鼻空肠管组,且PEG/J组患者自感舒适度好于鼻空肠管组(均P<0.05)。结论:早期EN治疗SAP时,PEG/J术置管要比鼻空肠管效果好,而且其并发症少,特别有利于SAP的后期营养支持治疗和病情恢复。

Percutaneous endoscopic gastrostomy/jejunostomy technique versus nasojejunal tube in nutritional support for severe acute pancreatitis

Objective: To compare the clinical efficacies between percutaneous endoscopic gastrostomy/jejunostomy(PEG/J) insertion and nasojejunal tube in enteral nutrition(EN) for severe acute pancreatitis(SAP). Methods: The treatment records of 61 SAP patients were retrospectively analyzed.Fifteen cases underwent PEG/J insertion(PEG/J group) and the other 46 cases received nasojejunal tube feeding(nasojejunal tube group).The operative time,time to first defecation,time for hemogram returning to normal,incidence of catheter-related lung infection,duration of feeding tube retention and subjective comfort levels of the two groups were compared. Results: PEG/J group had a prolonged operative time,but faster recovery of bowel function and shorter time for hemogram to return to normal compared with nasojejunal tube group(all P<0.05).In PEG/J group,the duration of tube retention was longer,but the incidence of catheter-related lung infection was lower and the subjective comfort level was better than those of nasojejunal tube group(all P<0.05). Conclusion: In early EN support for SAP,PEG/J insertion has better efficacy and fewer complications than those of nasojejunal tube feeding,which is beneficial for the late nutritional support and recovery of the SAP patients.