肠屏障功能早期保护对重症急性胰腺炎治疗的影响

目的探讨肠屏障功能早期保护在重症急性胰腺炎(SAP)治疗中的重要性。方法 SAP患者60例随机分为治疗组和对照组各30例,对照组采用常规治疗,治疗组在对照组治疗基础上实施肠屏障早期保护措施。比较2组胃肠功能评分和APACHEⅡ评分、C-反应蛋白(CRP)、血清肿瘤坏死因子-α(TNF-α)、血浆内毒素水平、尿乳果糖/甘露醇值(L/M),以及预后情况。结果治疗组治疗3、5、7d后APACHEⅡ评分和胃肠功能评分均低于本组治疗前和同一时间段的对照组;对照组治疗5、7d后APACHEⅡ评分和胃肠功能评分低于治疗前,差异均有统计学意义(P<0.01和P<0.05)。治疗组治疗7d后L/M、内毒素低于治疗前;对照组治疗3、5、7d后L/M值高于治疗前;治疗组治疗3、5、7d后L/M值低于对照组,治疗7d后内毒素低于对照组,差异均有统计学意义(P<0.01和P<0.05)。2组CRP、TNF-α水平均呈先升高后下降趋势。治疗组治疗5、7d后CRP水平低于治疗前,治疗3、5、7d后TNF-α水平低于治疗前;治疗组治疗3、5、7d后CRP、TNF-α水平均低于对照组,差异均有统计学意义(P<0.01和P<0.05)。2组预后不良发生率比较,差异有统计学意义(P<0.05)。结论早期进行肠屏障功能保护能有效提高患者胃肠功能,降低肠屏障通透性和炎性反应。

Effect of early intestinal barrier function protection on severe acute pancreatitis

Objective To investigate the importance of early intestinal barrier function protection in the treatment of severe acute pancreatitis.Methods 60 cases of patients with severe acute pancreatitis were randomly divided into treatment group and control group,each of 30 cases.The control group were given conventional treatment,and the treatment group were added with early intestinal barrier function protection based on the control group.Compared the gastrointestinal dysfunction score,APACHE Ⅱscore,CRP,TNF-α,plasma endotoxin level,L/M and the conditions of prognosis of 2 groups.Results 3、5 and 7 days after treatment,the APACHE Ⅱ score and gastrointestinal function scores of the treatment group were significantly decreased Compared with before treatment and the control group;5 and 7 days after treatment,the APACHE Ⅱ score and gastrointestinal function scores of the control group were significantly decreased Compared with before treatment,and the differences were statistically significant（P〈0.01 and P〈0.05）.7 days after treatment,the L/M and endotoxin of the treatment group were lower than before treatment;3、5 and 7 days after treatment,the L/M of the control group was higher than before treatment;3、5 and 7 days after treatment,the L/M of the treatment group was lower than that of the control group;7 days after treatment,the endotoxin of the treatment group was lower than that of the control group,and the differences were statistically significant（P〈0.01 and P〈0.05）.The level of CRP、TNFα of 2 groups increased firstly and then decreased later.5 and 7 days after treatment,the CRP level of the treatment group was lower than before treatment;3、5 and 7 days after treatment,the TNFα of the treatment group was lower than before treatment;3、5 and 7 days after treatment,the CRP and TNF-α level of the treatment group were lower than that of the control group,and the differences were statistically significant（P〈0.01 and P〈0.05）.The poor prognosis incidence of the treatment group was significantly lower than that of the control group,and the difference was statistically significant（P〈0.05）.Conclusion Early intestinal barrier function protection can effectively improve patients＇ gastrointestinal function and reduce intestinal barrier permeability and inflammatory responses.