早期经鼻肠内营养对中-重度急性胰腺炎患者的疗效观察

doi:10.3969/j.issn.1000-8535.2020.02.017

摘要/Abstract

摘要： 目的观察早期经鼻肠内营养(ENEN)对中-重度急性胰腺炎(MSAP+SAP)患者的治疗效果。方法回顾性分析2014年9月—2019年5月期间,广东药科大学附属第一医院消化内科收治的50例MSAP及SAP患者临床资料,根据患者营养支持治疗方式不同,将患者分为观察组(n=25)和对照组(n=25)。观察组患者采用ENEN治疗,对照组采用肠外肠内营养联合(PNEN)治疗。对比两组患者治疗后血清白蛋白(ALB)、血清前白蛋白(PA)、C-反应蛋白(CRP)、急性生理与慢性健康(APACHE Ⅱ)评分、序贯器官功能衰竭(SOFA)评分及多器官功能障碍综合征(MODS)发生率。结果经过治疗后,观察组患者ALB水平、PA水平高于对照组,CRP水平低于对照组,差异有统计学意义(P＜0.05)。经过治疗后,观察组患者APACHE Ⅱ评分、SOFA评分低于对照组,差异有统计学意义(P＜0.05)。经过治疗后,观察组患者MODS发生率低于对照组,差异有统计学意义(P＜0.05)。结论 ENEN治疗MSAP及SAP患者可有效改善患者营养状态和健康状况,降低机体炎症反应,减少MODS发生率。

关键词: 中重度急性胰腺炎, 早期, 肠内营养, 炎症反应, 功能衰竭

Abstract: Objective To observe the effect of early nasal enteral nutrition(ENEN) on patients with moderate to severe acute pancreatitis(MSAP+SAP). Methods A retrospective analysis of the clinical data of 58 patients with(MSAP+SAP) admitted to the department of gastroenterology, the First Affiliated Hospital of Guangdong Pharmaceutical University from September 2014 to May 2019, according to the different nutritional support treatment methods, the patients were divided into observation groups(n=25) and control group(n=25). Patients in the observation group were treated with ENEN, and the control group was treated with Parenteral nutrition and enteral nutrition(PNEN). Serum albumin(ALB), serum prealbumin(PA), C-reactive protein(CRP), acute physiology and chronic health evaluation(APACHE II) score, sequential organ failure assessment(SOFA) score, and incidence of multiple organ dysfunction syndrome(MODS) were compared between the two groups. Results After treatment, the ALB and PA level of the observation group were higher than those of the control group, and the CRP level was lower than that of the control group, the difference was statistically significant(P<0.05). After treatment, the APACHE II score and SOFA score of the observation group were lower than those of the control group, and the difference was statistically significant(P<0.05). After treatment, the incidence of MODS in the observation group was lower than that in the control group, and the difference was statistically significant(P<0.05). Conclusion ENEN treatment of MSAP and SAP may effectively improve the nutritional status and health of patients, reduce the body's inflammatory response and reduce the incidence of MODS.

Key words: Moderate to severe acute pancreatitis, Early, Enteral nutrition, Inflammatory response, Functional failure

彭慧芸, 袁瑜, 谢文瑞, 吴礼浩. 早期经鼻肠内营养对中-重度急性胰腺炎患者的疗效观察[J]. 广州医药, 2020, 51(2): 77-80.

PENG Huiyun, YUAN Yu, XIE Wenrui, WU Lihao. Therapeutic effect of early nasal enteral nutrition on patients with moderate to severe acute pancreatitis[J]. Guangzhou Medical Journal, 2020, 51(2): 77-80.

参考文献

[1] MAHESHWARI R, SUBRAMANIAN R M. Severe acute pancreatitis and necrotizing pancreatitis[J]. Crit Care Clin, 2016, 32(2): 279-290.
[2] FENG P, HE C, LIAO G, et al. Early enteral nutrition versus delayed enteral nutrition in acute pancreatitis: a PRISMA-compliant systematic review and meta-analysis[J]. Med, 2017, 96(46):e8648.
[3] van DIJK S M, HALLENSLEBEN N D L, van SANTVOORT H C, et al. Acute pancreatitis: recent advances through randomised trials[J]. Gut, 2017, 66(11): 2024-2032.
[4] MCCLAVE S A, TAYLOR B E, MARTINDALE R G, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine(SCCM) and American Society for Parenteral and Enteral Nutrition(ASPEN)[J]. J Parenter Enteral Nutr, 2016, 40(2): 159-211.
[5] BLASER A R, STARKOPF J, ALHAZZANI W, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines[J]. Intensive Care Med, 2017, 43(3): 380-398.
[6] 中华医学会消化病学分会胰腺疾病学组, 《中华胰腺病杂志》编辑委员会, 《中华消化杂志》编辑委员会,等. 中国急性胰腺炎诊治指南(2013,上海)[J]. 中国实用内科杂志, 2013, 13(7):73-78.
[7] ALI U A, ISSA Y, HAGENAARS J C, et al. Risk of recurrent pancreatitis and progression to chronic pancreatitis after a first episode of acute pancreatitis[J]. Clin Gastroenterol Hepatol, 2016, 14(5): 738-746.
[8] LIU T, HUANG W, SZATMARY P, et al. Accuracy of circulating histones in predicting persistent organ failure and mortality in patients with acute pancreatitis[J]. Bri J Surg, 2017, 104(9): 1215-1225.
[9] 李卉, 彭富治, 杨振宇, 等. 中度重症急性胰腺炎患者早期经胃管和空肠管行肠内营养治疗的疗效对比[J]. 实用药物与临床, 2018, 21(11):64-68.
[10] 罗旭娟, 唐川康, 汪敏,等. 鼻胃管肠内营养对中—重度急性胰腺炎的临床疗效研究[J]. 肠外与肠内营养, 2017, 24(5):19-24.
[11] YONG L, LU Q P, LIU S H, et al. Efficacy of glutamine-enriched nutrition support for patients with severe acute pancreatitis: a meta-analysis[J]. J Parenter Enteral Nutr, 2016, 40(1): 83-94.
[12] 叶劲松, 罗旭, 梁昭, 等. BISAP评分在重症急性胰腺炎预后评估中的应用价值[J]. 现代医院, 2019,19(6):884-886.
[13] DI MARTINO M, MADDEN A M, GURUSAMY K S. Nutritional supplementation in enteral and parenteral nutrition for people with acute pancreatitis[J]. Cochrane Database Syst Rev, 2019, 25(1):701-710.
[14] 黄建刚, 杨青, 胡翠, 等. 不同严重程度急性胰腺炎患者血小板线粒体氧化功能比较[J]. 山东医药, 2018, 58(38):60-62.
[15] 刘爱茹. 早期液体复苏对中度重症及重症急性胰腺炎预后影响研究[D]. 海军军医大学,2018.
[16] 杨立新, 刘静, 邢云, 等. 大黄经鼻空肠管给药治疗中度急性胰腺炎的随机对照研究[J]. 中国中西医结合杂志, 2017,21(3):50-53.
[17] 李月月, 韦维. 胰腺炎症反应机制及相关信号通路研究进展[J]. 现代医院, 2019, 21(6):858-862.