CAJ | 학술논문

目的观察肠内营养对急性重症胰腺炎病人的作用，研究其应用时机、途径及肠内营养制剂的选择。方法按亚特兰大(Atlanta)国际会议的诊断标准，收集急性重症胰腺炎病人40例，随机分成两组。分别给予全肠内营养(TEN)和全肠外营养(TPN)支持。两组总热量的供给、开始的时间和支持的天数相同。在TEN组采用荷兰NUTRICIA公司提供的螺旋形鼻肠管CH10。导管的尖端应达到Treitz韧带以下。在TEN组，肠内营养制剂能全力(NutrisonFibre)、百普素(Pepti-2000)和爱伦多(ELENTAL)的应用各占1/3。监测所有病人的血清白蛋白、前白蛋白、转铁蛋白、IgG、IgM、IgA、肝酶谱以及血、尿淀粉酶，定期复查CT。所得数据采用SPSS8.0软件进行统计分析，根据情况使用χ２检验或t检验。结果血清白蛋白浓度两组较营养支持前明显增高，但两组间无显著性差异。营养支持后第10天，前白蛋白、转铁蛋白和IgG水平TEN组比TPN明显升高，两组比较有显著性差异。肝酶谱的恢复TEN组明显优于TPN组。淀粉酶的下降和CT影像两组无明显差异。在TEN组中，接受能全力支持的病人胃肠道和代谢方面的并发症较少，病人容易接受。结论急性重症胰腺炎的病人早期肠内营养支持不仅重要，而且可行。肠内营养较肠外营养在增加快速反应蛋白的合成、改善肝功能和免疫功能、缓解炎性反应、增强肠道粘膜屏障功能以及减少TPN并发症等方面明显优于肠外营养。
목적관찰장내영양대급성중증이선염병인적작용，연구기응용시궤、도경급장내영양제제적선택。방법안아특란대(Atlanta)국제회의적진단표준，수집급성중증이선염병인40례，수궤분성량조。분별급여전장내영양(TEN)화전장외영양(TPN)지지。량조총열량적공급、개시적시간화지지적천수상동。재TEN조채용하란NUTRICIA공사제공적라선형비장관CH10。도관적첨단응체도Treitz인대이하。재TEN조，장내영양제제능전력(NutrisonFibre)、백보소(Pepti-2000)화애륜다(ELENTAL)적응용각점1/3。감측소유병인적혈청백단백、전백단백、전철단백、IgG、IgM、IgA、간매보이급혈、뇨정분매，정기복사CT。소득수거채용SPSS8.0연건진행통계분석，근거정황사용χ２검험혹t검험。결과혈청백단백농도량조교영양지지전명현증고，단량조간무현저성차이。영양지지후제10천，전백단백、전철단백화IgG수평TEN조비TPN명현승고，량조비교유현저성차이。간매보적회복TEN조명현우우TPN조。정분매적하강화CT영상량조무명현차이。재TEN조중，접수능전력지지적병인위장도화대사방면적병발증교소，병인용역접수。결론급성중증이선염적병인조기장내영양지지불부중요，이차가행。장내영양교장외영양재증가쾌속반응단백적합성、개선간공능화면역공능、완해염성반응、증강장도점막병장공능이급감소TPN병발증등방면명현우우장외영양。
Objective To observe the effect of enteral nutrition(EN) in thetreatment of patients with acute severe pancreatitis and to study its applying time,ways as well as the choice of EN preparation. Methods 40 cases of acute severe pancreatitis were collected according to diagnostic standard in the Atlanta international meeting,these patients were divided into two groups on the basis of stochastics in which was given TEN and TPN support separately.The supply of total heat,the time of beginning and supporting days are same in this two groups.Catheter from nose to intestine which was provided by UNTRICIA copany has been applied in the TEN group,the tip of catheter should be up to below of Treitz ligament.The use of EN preparation-Nutrison Fibre,Pepti-2000 and Elental were occupied 1/3 respectively in TEN group.The serum albumin,prealbumin,transferring,IgG,IgM,IgA,liver function and blood as well as urinary amylase in all patients were monitored,meanwhile CT follow-up examination was taken regularly.The data from above methods were proceeded to count and to analyze under SPSS 8.0 computer soft,at same time,the data were also tested by χ２ analysis TEST or T analysis. Results The concentration of serum albumin in patients of two groups apparently was increased before obtaining the EN support,but there is not apparently difference between two groups.The level of albumin()in TEN group was clearly increased compare with that in TPN group after the ten days getting EN support,the apparently differences were seen through comparing two groups's patients.The recovery of liver function in TEN group were obvious more than that in TPN group.There is no obvious difference in the aspect of amylase'dropping and CT pictures in two groups.For these patients getting full EN support,the opportunity affecting complication of stomach and intestinal tract as well as metabolism were less,and the patient is easy to accept it. Conclusions Early EN support in patients with acute severe pancreatitis not only is important but also feasible.EN has apparent advantage compare with PN in the aspect of increasing the synthesis of rapidly reactive albumen,improving liver function and immunity function,mitigating the acute reaction and enhancing the function of intestinal tract's mucous as barrier,reducing TPN complication.