中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
26期
3-6
,共4页
汪泳%张方信%邓尚新%常宗宏%刘鑫%秦世钊%李斌
汪泳%張方信%鄧尚新%常宗宏%劉鑫%秦世釗%李斌
왕영%장방신%산상신%상종굉%류흠%진세쇠%리빈
胰腺炎%营养疗法%肠道营养
胰腺炎%營養療法%腸道營養
이선염%영양요법%장도영양
Pancreatitis%Nutrition therapy%Enteral nutrition
目的 探讨重症急性胰腺炎患者营养治疗的策略.方法 选择208例重症急性胰腺炎患者,采用随机数字表法进行分组,早期肠内营养(EEN)组:于发病72 h内通过鼻空肠管给予肠内营养;晚期肠内营养(LEN)组,于发病6d后通过鼻空肠管给予肠内营养;完全肠外营养(TPN)组.观察各组患者治疗前后相关营养指标、并发症发生情况,评估其疗效和安全性.结果 EEN组67例,LEN组72例,TPN组69例.EEN组和LEN组治疗14d时营养不良发生率均低于TPN组[59.7％(40/67)、58.3％(42/72)比84.1％(58/69)],差异均有统计学意义(P＜0.05),但EEN组与LEN组比较差异无统计学意义(P＞0.05);三组高脂血症和高糖血症发生率比较差异无统计学意义(P＞0.05).三组治疗14 d时血清白蛋白、前白蛋白、视黄醇结合蛋白与治疗前比较差异均有统计学意义(P＜0.05).EEN组和LEN组治疗14 d时血清白蛋白、前白蛋白、视黄醇结合蛋白与TPN组比较差异有统计学意义(P＜0.05),EEN组与LEN组比较差异无统计学意义(P＞0.05).TPN组总感染、腹腔感染、血液感染和继发感染的发生率均高于EEN组和LEN组[62.3％(43/69)比25.4％(17/67)、19.4％(14/72),21.7％ (15/69)比4.5％ (3/67)、6.9％(5/72),39.1％ (27/69)比14.9％(10/67)、11.1％(8/72),33.3％(23/69)比9.0％(6/67)、9.7％(7/72)],差异有统计学意义(P＜0.05);三组胰周感染、肺部感染发生率比较差异无统计学意义(P＞0.05).LEN组与EEN组总感染和不同感染发生率比较差异无统计学意义(P＞0.05).三组各种非感染性并发症发生率比较差异无统计学意义(P＞ 0.05);LEN组和EEN组的治愈率均优于TPN组[91.0％(61/67)、94.4％(68/72)比81.2％(56/69)],差异均有统计学意义(P＜0.05),但LEN组与EEN组比较差异无统计学意义(P＞0.05).结论 重症急性胰腺炎患者EEN治疗是安全有效的,并可明显改善患者的预后.
目的 探討重癥急性胰腺炎患者營養治療的策略.方法 選擇208例重癥急性胰腺炎患者,採用隨機數字錶法進行分組,早期腸內營養(EEN)組:于髮病72 h內通過鼻空腸管給予腸內營養;晚期腸內營養(LEN)組,于髮病6d後通過鼻空腸管給予腸內營養;完全腸外營養(TPN)組.觀察各組患者治療前後相關營養指標、併髮癥髮生情況,評估其療效和安全性.結果 EEN組67例,LEN組72例,TPN組69例.EEN組和LEN組治療14d時營養不良髮生率均低于TPN組[59.7％(40/67)、58.3％(42/72)比84.1％(58/69)],差異均有統計學意義(P＜0.05),但EEN組與LEN組比較差異無統計學意義(P＞0.05);三組高脂血癥和高糖血癥髮生率比較差異無統計學意義(P＞0.05).三組治療14 d時血清白蛋白、前白蛋白、視黃醇結閤蛋白與治療前比較差異均有統計學意義(P＜0.05).EEN組和LEN組治療14 d時血清白蛋白、前白蛋白、視黃醇結閤蛋白與TPN組比較差異有統計學意義(P＜0.05),EEN組與LEN組比較差異無統計學意義(P＞0.05).TPN組總感染、腹腔感染、血液感染和繼髮感染的髮生率均高于EEN組和LEN組[62.3％(43/69)比25.4％(17/67)、19.4％(14/72),21.7％ (15/69)比4.5％ (3/67)、6.9％(5/72),39.1％ (27/69)比14.9％(10/67)、11.1％(8/72),33.3％(23/69)比9.0％(6/67)、9.7％(7/72)],差異有統計學意義(P＜0.05);三組胰週感染、肺部感染髮生率比較差異無統計學意義(P＞0.05).LEN組與EEN組總感染和不同感染髮生率比較差異無統計學意義(P＞0.05).三組各種非感染性併髮癥髮生率比較差異無統計學意義(P＞ 0.05);LEN組和EEN組的治愈率均優于TPN組[91.0％(61/67)、94.4％(68/72)比81.2％(56/69)],差異均有統計學意義(P＜0.05),但LEN組與EEN組比較差異無統計學意義(P＞0.05).結論 重癥急性胰腺炎患者EEN治療是安全有效的,併可明顯改善患者的預後.
목적 탐토중증급성이선염환자영양치료적책략.방법 선택208례중증급성이선염환자,채용수궤수자표법진행분조,조기장내영양(EEN)조:우발병72 h내통과비공장관급여장내영양;만기장내영양(LEN)조,우발병6d후통과비공장관급여장내영양;완전장외영양(TPN)조.관찰각조환자치료전후상관영양지표、병발증발생정황,평고기료효화안전성.결과 EEN조67례,LEN조72례,TPN조69례.EEN조화LEN조치료14d시영양불량발생솔균저우TPN조[59.7％(40/67)、58.3％(42/72)비84.1％(58/69)],차이균유통계학의의(P＜0.05),단EEN조여LEN조비교차이무통계학의의(P＞0.05);삼조고지혈증화고당혈증발생솔비교차이무통계학의의(P＞0.05).삼조치료14 d시혈청백단백、전백단백、시황순결합단백여치료전비교차이균유통계학의의(P＜0.05).EEN조화LEN조치료14 d시혈청백단백、전백단백、시황순결합단백여TPN조비교차이유통계학의의(P＜0.05),EEN조여LEN조비교차이무통계학의의(P＞0.05).TPN조총감염、복강감염、혈액감염화계발감염적발생솔균고우EEN조화LEN조[62.3％(43/69)비25.4％(17/67)、19.4％(14/72),21.7％ (15/69)비4.5％ (3/67)、6.9％(5/72),39.1％ (27/69)비14.9％(10/67)、11.1％(8/72),33.3％(23/69)비9.0％(6/67)、9.7％(7/72)],차이유통계학의의(P＜0.05);삼조이주감염、폐부감염발생솔비교차이무통계학의의(P＞0.05).LEN조여EEN조총감염화불동감염발생솔비교차이무통계학의의(P＞0.05).삼조각충비감염성병발증발생솔비교차이무통계학의의(P＞ 0.05);LEN조화EEN조적치유솔균우우TPN조[91.0％(61/67)、94.4％(68/72)비81.2％(56/69)],차이균유통계학의의(P＜0.05),단LEN조여EEN조비교차이무통계학의의(P＞0.05).결론 중증급성이선염환자EEN치료시안전유효적,병가명현개선환자적예후.
Objective To investigate the strategies of nutritional therapy for severe acute pancreatitis (SAP) patients.Methods Two hundred and eight patients with SAP were randomly divided into early enteral nutrition (EEN) group,late enteral nutrition (LEN) group and total enteral nutrition (TPN) group.EEN group received enteral nutrition through nasojejunal tube feeding within 72 hours in the course of disease,LEN group received the same treatment after 6 d in the course of disease,TPN group received total enteral nutrition.The index of nutrition,incidence of complication were recorded,efficacy and safety were analyzed.Results EEN group included 67 cases,while 72 cases in LEN group and 69 cases in TPN group.The incidence rate of malnutrition after 14 d of treatment in EEN group and LEN group was significantly lower than that in TPN group [59.7％ (40/67),58.3％ (42/72) vs.84.1％ (58/69),P ＜0.05],but the difference between EEN group and LEN group was not statistically significant (P ＞ 0.05).There was no statistically significant difference in the incidence of hyperlipidemia and hyperglycemia among three groups (P ＞ 0.05).The expression level of albumin,prealbumin and retinol-binding protein after 14 d of treatment in three groups compared with those before treatment and the differences were statistically significant (P ＜ 0.05).The expression level of albumin,prealbumin and retinol-binding protein after 14 d of treatment in EEN group and LEN group compared with those in TPN group and the differences were statistically significant (P＜ 0.05),there was no statistically significant difference between EEN group and LEN group (P＞ 0.05).The incidence rate of total infections,abdominal infections,bloodstream infections,secondary superinfections in TPN group were significantly lower than those in EEN group and LEN group [62.3％(43/69) vs.25.4％ (17/67),19.4％(14/72) ;21.7％(15/69) vs.4.5％(3/67),6.9％ (5/72);39.1％(27/69) vs.14.9％(10/67),11.1％(8/72) ;33.3％ (23/69) vs.9.0％ (6/67),9.7％(7/72),P ＜ 0.05],there was no statistically significant difference in the incidence of peripancreatic infections,lung infections among three groups (P ＞ 0.05).There was no statistically significant difference in the incidence of total infections,different infections between EEN group and LEN group.There was no statistically significant difference in the incidence of noninfections among three groups (P ＞ 0.05).The rate of recovery in EEN group and LEN group was significanby higher than that in TPN group [91.0％ (61/67),94.4％ (68/72) vs.81.2％ (56/69),P ＜ 0.05],but the difference between EEN group and LEN group was not statistically significant (P ＞ 0.05).Conclusion Early enteral nutrition therapy for SAP patients is safe and effective,and could significantly improve the prognosis of patients.
