中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2011年
5期
370-373
,共4页
许春芳%黄晓曦%沈云志%王兴鹏%龚磊%王亚东
許春芳%黃曉晞%瀋雲誌%王興鵬%龔磊%王亞東
허춘방%황효희%침운지%왕흥붕%공뢰%왕아동
肠道营养%胃肠外营养,全%重症急性胰腺炎%肠屏障功能
腸道營養%胃腸外營養,全%重癥急性胰腺炎%腸屏障功能
장도영양%위장외영양,전%중증급성이선염%장병장공능
Enteral nutrition%Parenteral nutrition,total%Severe acute pancreatitis%Gut barrier function
目的 研究肠内与肠外营养对重症急性胰腺炎(SAP)患者肠屏障功能的影响.方法 苏州大学附属第一医院、上海交通大学附属第一医院、无锡市第二人民医院及泰州市人民医院4家单位符合SAP入选标准的63例患者随机分为肠内营养(EN)组及全肠外营养(TPN)组.其中,29例接受EN,经鼻空肠管给予高能肠内营养液;34例接受TPN,通过静脉补充营养液.观察两组患者的血清内毒素、二胺氧化酶(DAO)水平及尿乳果糖/甘露醇(L/M)比值的变化.结果 在第7、14、21天,EN组血清内毒素水平均明显低于TPN组[(39.30±15.82)EU/L比(73.05±21.16)EU/L、(22.64±14.31)EU/L比(49.34±24.54)EU/L、(14.81±10.93)EU/L比(30.08±14.10)EU/L,P值均＜0.05];在第7、14天,EN组的血浆DAO水平均明显低于TPN组[(9.97±3.84)U/L比(19.89±9.89)U/L、(5.42±1.84)U/L比(8.79±4.08)U/L,P值均＜0.05];在第7、14、21天,EN组的尿L/M比值明显低于TPN组(0.28±0.25比0.65±0.45、0.21±0.18比0.54±0.41、0.08±0.04比0.29±0.06,P值均＜0.05).结论 EN在改善肠屏障功能方面优于TPN.
目的 研究腸內與腸外營養對重癥急性胰腺炎(SAP)患者腸屏障功能的影響.方法 囌州大學附屬第一醫院、上海交通大學附屬第一醫院、無錫市第二人民醫院及泰州市人民醫院4傢單位符閤SAP入選標準的63例患者隨機分為腸內營養(EN)組及全腸外營養(TPN)組.其中,29例接受EN,經鼻空腸管給予高能腸內營養液;34例接受TPN,通過靜脈補充營養液.觀察兩組患者的血清內毒素、二胺氧化酶(DAO)水平及尿乳果糖/甘露醇(L/M)比值的變化.結果 在第7、14、21天,EN組血清內毒素水平均明顯低于TPN組[(39.30±15.82)EU/L比(73.05±21.16)EU/L、(22.64±14.31)EU/L比(49.34±24.54)EU/L、(14.81±10.93)EU/L比(30.08±14.10)EU/L,P值均＜0.05];在第7、14天,EN組的血漿DAO水平均明顯低于TPN組[(9.97±3.84)U/L比(19.89±9.89)U/L、(5.42±1.84)U/L比(8.79±4.08)U/L,P值均＜0.05];在第7、14、21天,EN組的尿L/M比值明顯低于TPN組(0.28±0.25比0.65±0.45、0.21±0.18比0.54±0.41、0.08±0.04比0.29±0.06,P值均＜0.05).結論 EN在改善腸屏障功能方麵優于TPN.
목적 연구장내여장외영양대중증급성이선염(SAP)환자장병장공능적영향.방법 소주대학부속제일의원、상해교통대학부속제일의원、무석시제이인민의원급태주시인민의원4가단위부합SAP입선표준적63례환자수궤분위장내영양(EN)조급전장외영양(TPN)조.기중,29례접수EN,경비공장관급여고능장내영양액;34례접수TPN,통과정맥보충영양액.관찰량조환자적혈청내독소、이알양화매(DAO)수평급뇨유과당/감로순(L/M)비치적변화.결과 재제7、14、21천,EN조혈청내독소수평균명현저우TPN조[(39.30±15.82)EU/L비(73.05±21.16)EU/L、(22.64±14.31)EU/L비(49.34±24.54)EU/L、(14.81±10.93)EU/L비(30.08±14.10)EU/L,P치균＜0.05];재제7、14천,EN조적혈장DAO수평균명현저우TPN조[(9.97±3.84)U/L비(19.89±9.89)U/L、(5.42±1.84)U/L비(8.79±4.08)U/L,P치균＜0.05];재제7、14、21천,EN조적뇨L/M비치명현저우TPN조(0.28±0.25비0.65±0.45、0.21±0.18비0.54±0.41、0.08±0.04비0.29±0.06,P치균＜0.05).결론 EN재개선장병장공능방면우우TPN.
Objective To evaluate the effect of enteral nutrition (EN) versus total parenteral nutrition(TPN) on gut barrier function in patients with severe acute pancreatitis (SAP). Methods Sixtythree patients with SAP enrolled from 4 hospitals were randomly assigned into EN group(29 cases) and TPN group(34 cases). EN group patients were fed via a spiral nasojejunal feeding tube placed routinely by endoscopy or fluoroscopy, and TPN group patients were nourished intravenously with TPN during the same period. The changes of serum endotoxin, diamine oxidase, and urinary excretion of lactulose and mannitol ratio (L/M) were observed. Results Plasma concentration of endotoxin were markedly decreased in EN group as compared with that in TPN group at the 7th,14th ,21th day of entry trial [(39. 30 ± 15. 82) EU/L vs (73.05 ±21.16) EU/L,(22.64 ±14.31) EU/L vs (49.34 ±24.54) EU/L,(14.81 ± 10.93)EU/L vs ( 30. 08 ± 14. 10 ) EU/L, P ＜ 0. 05]. Plasma concentration of diamine oxidase were markedly decreased in EN group as compared with that in TPN group at the 7th, 14th day of entry trial [(9. 97 ± 3. 84)U/Lvs (19.89±9.89)U/L,(5.42±1. 84) U/Lvs (8.79 ±4.08) U/L, both P ＜ 0. 05]. The urinary L/M decreased significantly in EN group than those in TPN group at the 7th, 14th,21th day of entry trial (0.28 ±0.25 vs 0. 65 ±0.45,0.21 ±0. 18 vs 0.54 ±0.41,0.08 ±0.04 vs 0.29 ±0.06, all P＜0.05).Conclusion EN has better effect on improving intestinal barrier function than TPN in treatment of patients with SAP.
