肠内和肠外联合阶段性营养对重症急性胰腺炎患者治疗效果的影响

目的观察肠内和肠外联合阶段性营养对重症急性胰腺炎患者治疗效果的影响。方法重症急性胰腺炎患者45例分为完全胃肠外营养组（TPN组，n=25）和肠内营养加肠外阶段性营养组（PN＋EN组，n=20）。观察两组治疗结果以及临床指标的变化。结果营养支持后PN＋EN组的APACHEⅡ评分和CT评分均显著低于TPN组（P〈0．01）。营养支持两周后两组患者的血糖、血清淀粉酶和血肌酐水平均较营养支持前显著下降（P〈0．01），血清白蛋白、总蛋白、血钙水平均较营养支持前显著升高（P〈0．01），但是两组的各项指标比较无显著性差异（P〉0．05）。PN＋EN组患者的感染并发症发生率显著低于TPN组（P〈0．01），平均住院天数也显著短于TPN组（P〈0．01）。结论肠内和肠外联合阶段性营养支持方式的疗效优于完全胃肠外营养，对重症急性胰腺炎的治疗起了积极作用。

Combined Application of Staged Enteral and Parenteral Nutrition Support in Patients with Severe Acute Pancreatitis

Objective To assess the combined application of staged enteral and parenteral nutrition support in patients with severe acute pancreatitis. Methods Forty-five patients with severe acute pancreatitis who underwent conservative treatment were divided into total parenteral nutrition （TPN） group （ n = 25 ） and staged enteral nutrition and parenteral nutrition （ PN ＋ EN） group （ n = 20）. The changes of clinical indicators and clinical outcome were recorded. Results The APACHE Ⅱ score and CT score were significantly lower in the PN ＋ EN group than in the TPN group （P 〈 0. 01 ）. Two weeks after nutritional support, the blood glucose, serum creatinine, and serum amylase in both two groups significantly decreased （P 〈 0. 01 ）, while the blood calcium, serum albumin, and total protein significandy increased （P 〈 0.01 ）; however, no significant difference was found between these two groups. The incidence of infection complications was significandy lower in the PN ＋ EN group than in the TPN group （P 〈0. 01 ）. The average hospital stay was also significantly shorter in the PN ＋ EN group than in the TPN group （ P 〈0. 01 ）. Conclusion The combined application of staged EN ＋ PN nutrition support can remarkably improve the nutritional status of patients with severe acute pancreatitis.