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
7期
34-36
,共3页
胰腺炎,急性坏死性%肠道营养%胃肠外营养,全%肠屏障功能
胰腺炎,急性壞死性%腸道營養%胃腸外營養,全%腸屏障功能
이선염,급성배사성%장도영양%위장외영양,전%장병장공능
Pancreatitis,acute necrotizing%Enteral nutrition%Parenteral nutrition,total%Gut barrier function
目的 观察肠内营养(EN)对重症急性胰腺炎(SAP)患者肠屏障功能的影响,并探讨其在SAP治疗中的临床应用价值.方法 收集2009年12月至2011年12月收治的SAP患者40例,按照营养支持方式分为全胃肠外营养(TPN)组20例和EN组20例.分析两组急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分、血清内毒素、肠脂肪酸结合蛋白(IFABP)表达水平的差异.酶联免疫吸附试验方法检测血清内毒素和IFABP表达水平.结果 两组APACHEⅡ评分在治疗第1、7、14、21天呈逐渐降低趋势(P＜0.05),且EN组治疗第7、14、21天的APACHEⅡ评分显著低于TPN组[(7.03±1.86)分比(8.12±2.11)分、(5.32±1.14)分比(6.87±1.35)分、(3.49±0.83)分比(5.15±1.02)分,P＜ 0.05]；两组血清内毒素表达水平在治疗第1、7、14、21天呈逐渐减低趋势(P＜ 0.05),且EN组治疗第7、14、21天血清内毒素表达水平显著低于TPN组[(48.18±15.48) EU/L比(60.12±18.16) EU/L、(33.46±12.04) EU/L比(51.32±14.66) EU/L、(22.15±7.81) EU/L比(35.62±12.53)EU/L,P＜0.05]；两组血清IFABP表达水平在治疗第1、7、14、21天呈逐渐减低趋势(P＜0.05),且EN组治疗第7、14、21天血清IFABP表达水平显著低于TPN组[(18.47±3.55) ng/L比(22.57±4.14)ng/L、(10.32±2.68) ng/L比(18.11±3.62) ng/L、(6.39±2.26) ng/L比(12.16±3.06) ng/L,P＜0.05].相关性分析显示APACHEⅡ评分与血清内毒素(r=0.612,P＜0.05)和IFABP(r=0.634,P＜0.05)表达水平呈显著正相关,血清内毒素与IFABP表达水平亦呈显著正相关(r=0.627,P＜ 0.05).结论 EN治疗有助于SAP患者肠屏障功能的恢复,疗效优于TPN治疗,值得临床推广应用.
目的 觀察腸內營養(EN)對重癥急性胰腺炎(SAP)患者腸屏障功能的影響,併探討其在SAP治療中的臨床應用價值.方法 收集2009年12月至2011年12月收治的SAP患者40例,按照營養支持方式分為全胃腸外營養(TPN)組20例和EN組20例.分析兩組急性生理學與慢性健康狀況Ⅱ(APACHEⅡ)評分、血清內毒素、腸脂肪痠結閤蛋白(IFABP)錶達水平的差異.酶聯免疫吸附試驗方法檢測血清內毒素和IFABP錶達水平.結果 兩組APACHEⅡ評分在治療第1、7、14、21天呈逐漸降低趨勢(P＜0.05),且EN組治療第7、14、21天的APACHEⅡ評分顯著低于TPN組[(7.03±1.86)分比(8.12±2.11)分、(5.32±1.14)分比(6.87±1.35)分、(3.49±0.83)分比(5.15±1.02)分,P＜ 0.05]；兩組血清內毒素錶達水平在治療第1、7、14、21天呈逐漸減低趨勢(P＜ 0.05),且EN組治療第7、14、21天血清內毒素錶達水平顯著低于TPN組[(48.18±15.48) EU/L比(60.12±18.16) EU/L、(33.46±12.04) EU/L比(51.32±14.66) EU/L、(22.15±7.81) EU/L比(35.62±12.53)EU/L,P＜0.05]；兩組血清IFABP錶達水平在治療第1、7、14、21天呈逐漸減低趨勢(P＜0.05),且EN組治療第7、14、21天血清IFABP錶達水平顯著低于TPN組[(18.47±3.55) ng/L比(22.57±4.14)ng/L、(10.32±2.68) ng/L比(18.11±3.62) ng/L、(6.39±2.26) ng/L比(12.16±3.06) ng/L,P＜0.05].相關性分析顯示APACHEⅡ評分與血清內毒素(r=0.612,P＜0.05)和IFABP(r=0.634,P＜0.05)錶達水平呈顯著正相關,血清內毒素與IFABP錶達水平亦呈顯著正相關(r=0.627,P＜ 0.05).結論 EN治療有助于SAP患者腸屏障功能的恢複,療效優于TPN治療,值得臨床推廣應用.
목적 관찰장내영양(EN)대중증급성이선염(SAP)환자장병장공능적영향,병탐토기재SAP치료중적림상응용개치.방법 수집2009년12월지2011년12월수치적SAP환자40례,안조영양지지방식분위전위장외영양(TPN)조20례화EN조20례.분석량조급성생이학여만성건강상황Ⅱ(APACHEⅡ)평분、혈청내독소、장지방산결합단백(IFABP)표체수평적차이.매련면역흡부시험방법검측혈청내독소화IFABP표체수평.결과 량조APACHEⅡ평분재치료제1、7、14、21천정축점강저추세(P＜0.05),차EN조치료제7、14、21천적APACHEⅡ평분현저저우TPN조[(7.03±1.86)분비(8.12±2.11)분、(5.32±1.14)분비(6.87±1.35)분、(3.49±0.83)분비(5.15±1.02)분,P＜ 0.05]；량조혈청내독소표체수평재치료제1、7、14、21천정축점감저추세(P＜ 0.05),차EN조치료제7、14、21천혈청내독소표체수평현저저우TPN조[(48.18±15.48) EU/L비(60.12±18.16) EU/L、(33.46±12.04) EU/L비(51.32±14.66) EU/L、(22.15±7.81) EU/L비(35.62±12.53)EU/L,P＜0.05]；량조혈청IFABP표체수평재치료제1、7、14、21천정축점감저추세(P＜0.05),차EN조치료제7、14、21천혈청IFABP표체수평현저저우TPN조[(18.47±3.55) ng/L비(22.57±4.14)ng/L、(10.32±2.68) ng/L비(18.11±3.62) ng/L、(6.39±2.26) ng/L비(12.16±3.06) ng/L,P＜0.05].상관성분석현시APACHEⅡ평분여혈청내독소(r=0.612,P＜0.05)화IFABP(r=0.634,P＜0.05)표체수평정현저정상관,혈청내독소여IFABP표체수평역정현저정상관(r=0.627,P＜ 0.05).결론 EN치료유조우SAP환자장병장공능적회복,료효우우TPN치료,치득림상추엄응용.
Objective To investigate the effects of enteral nutrition (EN) on the gut barrier function in patients with severe acute pancreatitis (SAP) and explore its clinical significance.Methods A total of 40 SAP patients from December 2009 to December 2011 was collected in this study.The 40 cases were divided into total parenteral nutrition (TPN) group (20 cases) and EN group (20 cases).The APACHE Ⅱ score and serum expression of endotoxin and intestinal fatty acid binding protein (IFABP) were compared between two groups.The serum expression of endotoxin and IFABP was determined by enzyme-linked immunosorbent assay method.Results The APACHE Ⅱ score and serum expression of endotoxin and IFABP were significantly decreased in EN group and TPN group after treatment of 1,7,14,21 d (P ＜0.05).The APACHE Ⅱ score was lower in EN group than that in TPN group after treatment of 7,14,21 d [(7.03 ±1.86) scores vs.(8.12 ±2.11) scores,(5.32 ± 1.14) scores vs.(6.87 ± 1.35) scores,(3.49 ±0.83) scores vs.(5.15 ± 1.02) scores,P ＜ 0.05].The serum expression of endotoxin was lower in EN group than that in TPN group after treatment of 7,14,21 d [(48.18 ± 15.48) EU/L vs.(60.12 ± 18.16) EU/L,(33.46 ± 12.04) EU/L vs.(51.32 ± 14.66) EU/L,(22.15 ± 7.81) EU/L vs.(35.62 ± 12.53) EU/L,P ＜ 0.05].The serum expression of IFABP was lower in EN group than that in TPN group after treatment of 7,14,21 d [(18.47 ± 3.55) ng/L vs.(22.57 ± 4.14) ng/L,(10.32 ± 2.68) ng/L vs.(18.11 ± 3.62) ng/L,(6.39 ± 2.26)ng/L vs.(12.16 ±3.06) ng/L,P ＜0.05].The APACHE Ⅱ score was positively correlated with serum expression of endotoxin (r =0.612,P ＜ 0.05) and IFABP (r =0.634,P ＜ 0.05).The serum expression of endotoxin was positively correlated with IFABP (r =0.627,P ＜ 0.05).Conclusions EN treatment shows more effective effect on improving the gut barrier function in SAP patients than TPN treatment.And it is worthy to be popularized in the clinical application.
