CAJ | 학술논문

目的观察早期胃镜下置入鼻空肠管行肠内营养对急性重症胰腺炎(SAP)肠源性内毒素血症的治疗作用.方法 43例符合条件的SAP患者随机分为两组,肠内营养组24例:早期行胃镜下鼻空肠管置入行肠内营养治疗；全胃肠外营养组19例:行全肠外营养治疗.观察比较患者的腹痛、腹胀时间、血浆内毒素的改变,同时了解血浆白蛋白、淀粉酶恢复时间以及并发症发生率.结果肠内营养组患者腹痛、腹胀缓解时间分别为(3.3±2.2)、(7.6±3.2)d,明显优于全肠外营养组[分别为(7.1±3.8)、(13.3±4.9)d,F值分别为48.038、63.567,P均＜0.01],发生胃肠道出血0例、肺部及肠道感染1例、高血糖2例、胰腺囊肿1例,并发症亦少于全肠外营养组(分别为5、10、8、6例,x2值分别为7.147、13.084、6.777、5.847,P＜0.05或P＜0.001).血浆内毒素在肠内营养组中下降较早、较快,治疗后14 d降至(0.19±0.11)EU/ml,明显低于全肠外营养组的(0.85±0.28) EU/ml,两组间比较差异有统计学意义(t=10.456,P＜0.001).肠内营养组血浆淀粉酶治疗前及治疗后7、14 d分别为(1623±479)、(547±322)、( 179±106) U/L,全胃肠外营养组分别为(1467±589)、(789±503)、(233±156) U/L,两组血浆淀粉酶较治疗初期均显著降低,两组间比较在治疗后7、14 d时差异无统计学意义(t值分别为3.117、1.889,P均＞0.05).两组血浆白蛋白治疗后均升高,但两组间差异无统计学意义(P＞0.05).结论胃镜下鼻空肠管置入早期肠内营养治疗能显著改善SAP患者的症状、减少并发症、保护肠黏膜,有利于SAP肠源性内毒素血症的治疗.
목적 관찰조기위경하치입비공장관행장내영양대급성중증이선염(SAP)장원성내독소혈증적치료작용.방법 43례부합조건적SAP환자수궤분위량조,장내영양조24례:조기행위경하비공장관치입행장내영양치료；전위장외영양조19례:행전장외영양치료.관찰비교환자적복통、복창시간、혈장내독소적개변,동시료해혈장백단백、정분매회복시간이급병발증발생솔.결과 장내영양조환자복통、복창완해시간분별위(3.3±2.2)、(7.6±3.2)d,명현우우전장외영양조[분별위(7.1±3.8)、(13.3±4.9)d,F치분별위48.038、63.567,P균＜0.01],발생위장도출혈0례、폐부급장도감염1례、고혈당2례、이선낭종1례,병발증역소우전장외영양조(분별위5、10、8、6례,x2치분별위7.147、13.084、6.777、5.847,P＜0.05혹P＜0.001).혈장내독소재장내영양조중하강교조、교쾌,치료후14 d강지(0.19±0.11)EU/ml,명현저우전장외영양조적(0.85±0.28) EU/ml,량조간비교차이유통계학의의(t=10.456,P＜0.001).장내영양조혈장정분매치료전급치료후7、14 d분별위(1623±479)、(547±322)、( 179±106) U/L,전위장외영양조분별위(1467±589)、(789±503)、(233±156) U/L,량조혈장정분매교치료초기균현저강저,량조간비교재치료후7、14 d시차이무통계학의의(t치분별위3.117、1.889,P균＞0.05).량조혈장백단백치료후균승고,단량조간차이무통계학의의(P＞0.05).결론 위경하비공장관치입조기장내영양치료능현저개선SAP환자적증상、감소병발증、보호장점막,유리우SAP장원성내독소혈증적치료.
Objective To investigate the therapeutic effects of early enteral nutrition by gastroscopeguided naso-jejunal feeding tube placement on the intestinal endotoxemia of patient with severe acute pancreatitis (SAP).Methods Fourty-three patients were randomized into two groups:patients receiving early enteral nutrition (EN) by gastroscope-guided naso-jejunal feeding tube placement (24 cases) and those receiving total parenteral nutrition (TPN) ( 19 cases).The serum endotoxin(ET),albumin (ALB) and amylase (AMY) levels were measured.Abdominal distension and other complications were observed in the two groups.Results The abdominal pain and distension relief time,intestinal bleeding,infectious complications of EN group were significantly improved compared with that of TPN group ( P ＜ 0.01 或 P ＜ 0.05 或 P ＜ 0.001 ).The serum ET levels of EN group was much lower ( [ 0.19 ± 0.11 ] EU/ml) than that of TPN group ( [ 0.85 ± 0.28 ] EU/ml)on day 14 post-treatment (t =10.456,P ＜ 0.001 ).The serum AMY levels were decreased significantly in two groups after treatment,and the difference between two groups was not significant (t =3.l17,t =1.889,P ＞0.05 ).The serum ALB recovery of two groups was not significantly different ( P ＞ 0.05 ).Conclusion Gastroscope-guided Naso-jejunal feeding tube placement for early enteral nutrition can protect intestinal mucosa,reduce complications,alleviate symptoms of patients with SAP,which are benefitial factors for the treatment of intestinal endotoxemia in patients with SAP.