老年重症急性胰腺炎早期营养干预治疗策略的探讨

目的旨在通过对老年重症急性胰腺炎（severeacutepancreatitis，SAP）患者早期营养干预治疗的临床研究，反思传统观念的陈旧认识，为临床早期开始经鼻胃管肠道喂养提供科学依据。方法将48例人住ICU的SAP患者随机分为两组：经鼻胃管肠道喂养（EN）干预治疗组（EN组），25例，年龄60～80岁，中位数年龄71岁；全胃肠外喂养（TPN）干预治疗组（TPN组），23例，年龄60—80岁，中位数年龄68岁。动态检测两组患者的开始营养干预治疗时间、每日能量供量、经口进食时间、胃肠道症状、腹痛、C反应蛋白（CRP）、并发症等指标，观察期皆为5d。对两组的上述指标进行比较和统计学分析。结果（1）两组患者人住ICU后第l天的基本临床指标的差异没有统计学意义（P〉O．05），说明分组是随机的，具有可比性。（2）在人住ICU5天内两组患者的开始营养干预治疗时间、每日能量供量、经口进食时间、胃肠道症状、腹痛，经比较其差异均无统计学意义（P〉0．05），表明两组患者接受两种营养干预治疗的时间具有可比性；营养物质的摄人为等热量，两组恢复经口进食时间、发生胃肠道症状几率、腹痛的程度等均相当；入住ICU5d内患者的并发症发生率及第3天、第5天的CRP值，EN组均明显低于TPN组（p〈0．05），表明EN干预治疗比TPN干预治疗更明显降低患者的并发症发生率和减轻患者的全身炎症反应。结论经鼻胃管肠道喂养干预是治疗老年重症急性胰腺炎的有效方法，且比全胃肠外喂养干预治疗方法更优越，是一种积极、安全、有效、经济的治疗干预措施。

Clinical research on treatment strategies of early nutritional intervention to severe acute panereatitis in the elderly

Objective To provide the scientific basis for early starting nasogastric enteral nutrition through the clinical research on treatment strategies of early nutritional intervention to severe acute pancreatitis （SAP）. Methods 48 elderly patients with SAP in the ICU were randomly divided into two groups： nasogastric enteral nutrition （EN） group （o =25, age 60-80 years old, median age of 71 years old） ; total parenteral nutrition （TPN） group （n=23, age 60-80 years old, median age of 68 years old）. Assessments were taken in the starting time of nutritional intervention, daily energy intake, starting time of oral feeding, gastrointestinal symptoms, abdominal pain, C-reactive protein （CRP） level, and complications of clinical indicator. The observation periods was 5 d. All data in the two groups were statistically compared and analyzed, respectively. Results （1） After 1 d admission to ICU, the differences in above data between the two groups were not of statistical significance （P 〉 0.05）, thus representing that both divided groups were random and equally comparable. （2） After 5 d of admission into ICU, the data in the starting time of nutritional intervention, daily energy intake, starting time of oral feeding, gastrointestinal symptoms, abdominal pain in the two groups were not statistically different （P 〉 0.05）, respectively, indicating that the treatment time of the two nutrition interventions given to the patients in the two groups were comparable, while the intake calories of nutrients, starting time of oral feeding, occurrence probability of significant gastrointestinal symptoms and the degree of abdominal pain were also comparable. Within 5 d of admission into ICU, the incidences of complications and CRP levels of 3rd-day and 5th-day were significantly lower in EN group as compared with TPN group （P 〈 0.05）, showing EN significantly reduced complications and systemic inflammatory response of SAP. Conclusions Nasogastric enteral nutrition intervention is a effective treatment of severe acute pancreatitis in elderly patients, which is much better than the total parenteral nutrition treatment. EN also is a safe, positive, and economical treatment intervention.