保护肠屏障功能对重症急性胰腺炎患者预后的影响

背景:重症急性胰腺炎(SAP)患者死亡的主要原因是胰腺坏死组织继发感染以及与感染相关的器官衰竭.SAP时肠屏障功能障碍可导致肠源性感染,而后者在胰腺坏死组织继发感染中居主导地位.目的:评价保护肠屏障功能对SAP患者临床预后的影响,探讨肠屏障功能障碍在SAP中的作用.方法:回顾性分析131例SAP患者的治疗方法和预后.根据治疗方法将患者分为两组,A组患者接受包括加强监护、抑制胰酶分泌和抗感染等在内的传统治疗方案,B组患者在A组治疗的基础上加用改善微循环制剂、生大黄、微生态制剂、谷氨酰胺制剂和肠内营养以保护肠屏障功能.比较两组患者的感染率、并发症发生率、手术率和死亡率.结果:B组患者的感染率、胰腺脓肿、器官衰竭尤其是急性呼吸窘迫综合征(ARDS)的发生率显著低于A组患者(46.3%对70.3%、0.0%对6.2%、28.4%对37.5%和20.9%对31.2%;P＜0.05);手术率和死亡率亦显著低于A组(4.5%对12.5%和6.0%对14.1%;P＜0.05).结论:保护肠屏障功能有助于降低SAP患者的感染率和并发症发生率,从而改善其预后.

Effects of Intestinal Barrier Function Protection on Prognosis of Patients with Severe Acute Pancreatitis

Secondary infection of pancreatic necrotic tissue and infection-related organ failure are the main causes of death in patients with severe acute pancreatitis (SAP). Intestinal barrier dysfunction in SAP can lead to enterogenic infection, which is the key contributing factor of secondary pancreatic infection. Aims: To evaluate the effects of intestinal barrier function protection on the clinical outcome of SAP patients, and to investigate the role of intestinal barrier dysfunction during the course of SAP. Methods: The therapeutic regimen and clinical outcome of 131 SAP patients were retrospectively analyzed. All patients were divided into two groups according to the regimens used. Group A received the traditional therapeutic regimen consisting of intensive care, inhibition of pancreatic secretion and antibiotics. In group B, in addition to the therapeutic regimen employed in group A, improving microcirculation, rhubarb, microbial agents, glutamine and enteral nutrition were added to protect the intestinal barrier function. The infection rate, complication rate, operation rate and mortality of two groups were compared. Results: In group B, the infection rate, and the rates of pancreatic abscess, organ failure, especially acute respiratory distress syndrome (ARDS) were significantly lower than those in group A (46.3% vs. 70.3%, 0.0% vs. 6.2%, 28.4% vs. 37.5%, and 20.9% vs. 31.2%, respectively; P<0.05), so were the operation rate and mortality (4.5% vs. 12.5%, and 6.0% vs. 14.1%, respectively; P<0.05). Conclusions: Protection of intestinal barrier function is helpful in decreasing the infection rate and complications in SAP patients, and the prognosis can be improved accordingly.