CAJ | 학술논문

目的观察持续早期肠内营养联合谷氨酰胺及精氨酸对重症急性胰腺炎(SAP)患者肠屏障功能的影响.方法 32例SAP患者随机分为早期肠内营养(EEN)组(18例)和EEN联合谷氨酰胺及精氨酸组(肠内免疫营养组,14例).EEN组患者在内环境稳定情况下,于发病后的72 h内给予等氮源、等热量的EEN,肠内免疫营养组联合应用谷氨酰胺及精氨酸.第1、7、14天行急性病理学与慢性健康状况评分(APACHE-Ⅱ评分)并检测血清淀粉酶,二胺氧化酶(DAO),C反应蛋白(CRP),血浆内毒素,尿乳果糖与甘露醇的比值.观察并发症的发生和住院时间、费用等指标的变化.结果 2组患者均耐受EEN,在第1、7、14天2组APACHE-Ⅱ评分比较差异均无统计学意义(均P＞0.05),DAO、CRP和血浆内毒素均呈递减趋势;在第7天,肠内免疫营养组血浆内毒素及尿乳果糖与甘露醇的比值分别为(10.0±3.8)EU/ml和0.29±0.15,而EEN组为(7.9±2.8)EU/ml和0.16±0.05,差异均有统计学意义(均P＜0.05),住院时间、费用差异均无统计学意义(均P＞0.05).结论 SAP患者实施EEN安全可行,EEN联合谷氨酰胺及精氨酸可降低SAP患者病程早期肠道通透性,减少内毒素的易位,对SAP患者肠屏障功能有保护作用.
목적 관찰지속조기장내영양연합곡안선알급정안산대중증급성이선염(SAP)환자장병장공능적영향.방법 32례SAP환자수궤분위조기장내영양(EEN)조(18례)화EEN연합곡안선알급정안산조(장내면역영양조,14례).EEN조환자재내배경은정정황하,우발병후적72 h내급여등담원、등열량적EEN,장내면역영양조연합응용곡안선알급정안산.제1、7、14천행급성병이학여만성건강상황평분(APACHE-Ⅱ평분)병검측혈청정분매,이알양화매(DAO),C반응단백(CRP),혈장내독소,뇨유과당여감로순적비치.관찰병발증적발생화주원시간、비용등지표적변화.결과 2조환자균내수EEN,재제1、7、14천2조APACHE-Ⅱ평분비교차이균무통계학의의(균P＞0.05),DAO、CRP화혈장내독소균정체감추세;재제7천,장내면역영양조혈장내독소급뇨유과당여감로순적비치분별위(10.0±3.8)EU/ml화0.29±0.15,이EEN조위(7.9±2.8)EU/ml화0.16±0.05,차이균유통계학의의(균P＜0.05),주원시간、비용차이균무통계학의의(균P＞0.05).결론 SAP환자실시EEN안전가행,EEN연합곡안선알급정안산가강저SAP환자병정조기장도통투성,감소내독소적역위,대SAP환자장병장공능유보호작용.
Objective To investigate the effects of continuous early enteral nutrition (EEN) supplemented with glutamine and arginine on gut barrier function in patients with severe acute pancreatitis (SAP). Methods Thirty two patients with a diagnosis of acute pancreatitis predicted to develop severe disease were randomized into 2 groups: EEN group (n = 18) and EEN + glut-mine and arginine group (enteral immunonutrition group, n = 14). EEN was initiated when homeostasis was achieved within 72 hours after attack, and both group received isocaloric isonitrogenoas nutrition. Glutamine and arginine were administered into jejunum in the enteral immunonutrition group. Serum amylase, plasma diamine oxidase (DAO), C-reactive protein (CRP), plasma endotoxin, urinary excretion of lactulose (L), and mannitol (M) were measured, and APACHE-Ⅱ scores were recorded on days 1, 7, and 14. Complications, and length and cost of hospitalization were recorded as well. Results EEN and enteral immunonutrition were both tolerated well. There was no difference in APACHE-Ⅱ score between the two groups(P ＞ 0.05). The DAO, CliP, plasma endotoxin, and urinary L/M levels decreased with the course of SAP. However, the plasma endotoxin and urinary L/M on day 7 of the enteral immunonutrition group were (10.0 ± 3.8) EU/ml and 0.29 ± 0.15 respectively, both significantly higher than those of the EEN group [ (7.9 ± 2.8) EU/ml and 0. 16±0.08 respectively, both P＜0.05]. The length of hospital stay and cost showed no differences between the two groups. Conclusion EEN is safe and feasible in treatment of SAP. Enteral immunonutrition containing glutamine and arginine improves the gut barrier function by reducing the gut permeability and decreasing plasma endotoxin level in the early stage of SAP.