中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2013年
9期
922-925
,共4页
重症急性胰腺炎%早期肠内营养%肠内免疫营养
重癥急性胰腺炎%早期腸內營養%腸內免疫營養
중증급성이선염%조기장내영양%장내면역영양
Severe acute pancreatitis%Early enteral nutrition%Immune nutrition
目的 比较加入谷氨酰胺的早期肠内免疫营养(EIN)与早期标准配方肠内营养(EEN)对重症急性胰腺炎(SAP)患者的疗效和临床价值.方法 选择28例SAP患者,应用随机数字表分为两组,入院后均给予禁食、抗感染、胃肠减压、抑酸、解痉、抑制胰酶、使用胰岛素减轻胰腺负担、维持水电解质平衡及肠外营养等治疗,于入院后72 h内置螺旋鼻空肠管,EEN组给予百普力肠内营养制剂,EIN组将谷氨酰胺颗粒以总量0.2 g/(kg,d)、每日分3次用少量温水溶解后加入肠内营养制剂百普力中,待患者完全恢复正常饮食后逐步减量直至停止.观察两组患者的APACHEⅡ、Ranson评分变化以及炎症指标、营养指标和免疫指标变化,同时统计首次排便时间、ICU监护时间、总住院时间、总住院费用、并发症发生率和病死率等.结果 两组患者均耐受早期肠内营养支持治疗,EIN组在治疗14天的免疫指标IgG[(19.14±2.03)g]显著高于EEN组[(13.79±3.29)g],差异有统计学意义(P＜0.05).EIN组患者在首次排便时间、ICU监护时间、总住院费用方面显著少于EEN组[(4.29±1.64)、(5.36-±0.84)d,(2.57 ±0.85)、(3.64±1.60)d,(34.36 ±3.59)万元与(43.86 ±9.43)万元],差异均有统计学意义(t值分别为2.179、2.213、3.518,P均＜0.05).结论 SAP患者实施EIN安全可行,EIN和EEN均可明显减轻SAP患者的炎症反应,提高营养状况,但EIN在改善SAP患者免疫功能以及预后方面优于EEN.
目的 比較加入穀氨酰胺的早期腸內免疫營養(EIN)與早期標準配方腸內營養(EEN)對重癥急性胰腺炎(SAP)患者的療效和臨床價值.方法 選擇28例SAP患者,應用隨機數字錶分為兩組,入院後均給予禁食、抗感染、胃腸減壓、抑痠、解痙、抑製胰酶、使用胰島素減輕胰腺負擔、維持水電解質平衡及腸外營養等治療,于入院後72 h內置螺鏇鼻空腸管,EEN組給予百普力腸內營養製劑,EIN組將穀氨酰胺顆粒以總量0.2 g/(kg,d)、每日分3次用少量溫水溶解後加入腸內營養製劑百普力中,待患者完全恢複正常飲食後逐步減量直至停止.觀察兩組患者的APACHEⅡ、Ranson評分變化以及炎癥指標、營養指標和免疫指標變化,同時統計首次排便時間、ICU鑑護時間、總住院時間、總住院費用、併髮癥髮生率和病死率等.結果 兩組患者均耐受早期腸內營養支持治療,EIN組在治療14天的免疫指標IgG[(19.14±2.03)g]顯著高于EEN組[(13.79±3.29)g],差異有統計學意義(P＜0.05).EIN組患者在首次排便時間、ICU鑑護時間、總住院費用方麵顯著少于EEN組[(4.29±1.64)、(5.36-±0.84)d,(2.57 ±0.85)、(3.64±1.60)d,(34.36 ±3.59)萬元與(43.86 ±9.43)萬元],差異均有統計學意義(t值分彆為2.179、2.213、3.518,P均＜0.05).結論 SAP患者實施EIN安全可行,EIN和EEN均可明顯減輕SAP患者的炎癥反應,提高營養狀況,但EIN在改善SAP患者免疫功能以及預後方麵優于EEN.
목적 비교가입곡안선알적조기장내면역영양(EIN)여조기표준배방장내영양(EEN)대중증급성이선염(SAP)환자적료효화림상개치.방법 선택28례SAP환자,응용수궤수자표분위량조,입원후균급여금식、항감염、위장감압、억산、해경、억제이매、사용이도소감경이선부담、유지수전해질평형급장외영양등치료,우입원후72 h내치라선비공장관,EEN조급여백보력장내영양제제,EIN조장곡안선알과립이총량0.2 g/(kg,d)、매일분3차용소량온수용해후가입장내영양제제백보력중,대환자완전회복정상음식후축보감량직지정지.관찰량조환자적APACHEⅡ、Ranson평분변화이급염증지표、영양지표화면역지표변화,동시통계수차배편시간、ICU감호시간、총주원시간、총주원비용、병발증발생솔화병사솔등.결과 량조환자균내수조기장내영양지지치료,EIN조재치료14천적면역지표IgG[(19.14±2.03)g]현저고우EEN조[(13.79±3.29)g],차이유통계학의의(P＜0.05).EIN조환자재수차배편시간、ICU감호시간、총주원비용방면현저소우EEN조[(4.29±1.64)、(5.36-±0.84)d,(2.57 ±0.85)、(3.64±1.60)d,(34.36 ±3.59)만원여(43.86 ±9.43)만원],차이균유통계학의의(t치분별위2.179、2.213、3.518,P균＜0.05).결론 SAP환자실시EIN안전가행,EIN화EEN균가명현감경SAP환자적염증반응,제고영양상황,단EIN재개선SAP환자면역공능이급예후방면우우EEN.
Objective To compare the efficacy and clinical value of early enteral immunonutrition (EIN) combined with glutamine with early standard formula enteral nutrition (EEN) in patients with severe acute pancreatitis(SAP).Methods Twenty-eight patients with SAP were divided into two groups by random number table.Both groups were fasted,given treatments of anti-infection,gastrointestinal decompression,acidoresistance,spasmolysis,pancreatic enzyme inhibition,reduce the burden on the pancreas insulin,water electrolyte balance and parenteral nutrition upon admission into hospital.Spiral nasointestinal tube was implemented within 72 hours of patients' admission.The 14 cases in the EEN group were given treatment of early standard enteral nutrition by nasojejunal tube.The 14 cases in the EIN group received early enteral immunonutrition (glutamine granules,0.2 g/(kg · d),at least three times oral administration by dissolving in enteral nutritious agent peptison with a small amount of warm water).During the treatment,the dose of glutamine granules was reduced gradually until withdrawal when the patients in the EIN group started normal diet.The changes were observed in patients in terms of APACHE Ⅱ,Ranson score,inflammatory markers,nutritional and immune indicators,while monitoring the first defecation time,ICU care unit stay,total hospital stay,total hospitalization costs,complication rate and mortality data.Results Patients of both groups tolerated early enteral nutrition treatment.Fourteen days after treatment,the value of the immune indicator IgG was significantly higher in the EIN group than in the EEN group((19.14 ± 2.03) g vs.(13.79 ± 3.29) g,P ＜0.05).The first defecation time,ICU care days,total hospital costs were significantly shorter or less in patients in the EIN group than in those in the EEN group (first defecation time:((4.29 ± 1.64) d vs.(5.36 ± 0.84)d,t =2.179 ; ICU care:(2.57 ± 0.85) d vs.(3.64 ± 1.60) d,t =2.213 ; total hospital costs:(343.6 ±35.9)thousand yuan vs.(438.6±94.3) thousand yuan,t =3.518; P ＜0.05).Conclusion It is feasible and safety to implement EIN treatment in patients with severe acute pancreatitis.EIN and EEN could significantly reduce the inflammatory response and improve the nutritional status of patients with severe acute pancreatitis.But EIN is better in improving immune function and the prognosis of patients with severe acute pancreatitis than the EEN.
