中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2015年
7期
784-787
,共4页
张东%潘伟云%丁黎莉%王育珊
張東%潘偉雲%丁黎莉%王育珊
장동%반위운%정려리%왕육산
重症急性胰腺炎%急性胃肠损伤%营养支持%预后
重癥急性胰腺炎%急性胃腸損傷%營養支持%預後
중증급성이선염%급성위장손상%영양지지%예후
Severe acute pancreatitis%Acute gastrointestinal injury%Nutritional support%Prognosis
目的 探讨急性胃肠损伤(acute gastrointestinal injury,AGI)分级诊治策略在重症急性胰腺炎(severe acute pancreatitis,SAP)患者营养支持中的应用及对预后的影响.方法 纳入的研究对象为2012年1月至2013年12月吉林大学第一医院ICU收治的SAP患者,诊断标准参照中国急性胰腺炎诊治指南(2013年,上海);排除标准:年龄＜18岁、住院时间＜72 h、纳入其他试验研究.共计入选45例SAP患者,依据是否应用AGI分级诊治策略而分成AGI分级诊治组24例和对照组21例,两组患者的性别、年龄和APACHEⅡ评分之间比较差异无统计学意义(P＞0.05).统计和比较两组患者的住院时间及住院病死率,感染等并发症的发生率,以及肠内营养(enteral nutrition,EN)开始时间和EN达标时间(EN达到目标喂养量时间).计量资料比较采用成组t检验或Mann-Whitney U检验;计数资料比较采用x2检验或Fisher确切概率法检验,以P＜0.05为差异具有统计学意义.结果 (1) AGI分级诊治组和对照组患者的EN开始时间分别为2.0(1,2.8)d、5.7 (3.7,9.2)d,两组比较差异具有统计学意义(Z=-4.149,P＜0.01);AGI分级诊治组和对照组患者的EN达标时间分别为5.5 (3.3,8.8)d、10.4 (8.0,12.5)d,两组比较差异具有统计学意义(Z=-3.392,P=0.001).(2)比较AGI分级诊治组和对照组的肺部感染发生率,差异有统计学意义(25％ vs57.14％,P=0.028 1);两组导管相关感染发生率的差异亦有统计学意义(0％ vs.23.81％,P=0.039 4).(3)比较AGI分级诊治组和对照组的住院病死率,差异无统计学意义(16.67％ vs.33.33％,P=0.1943);比较两组患者住院时间的差异有统计学意义[(23.13±10.58) dvs.(31.10±15.33)d,P=0.046].结论 AGI分级诊治策略可使SAP患者在人院后更早接受EN支持和达到目标喂养量,并能够降低部分感染的发生率以及缩短住院时间,为临床SAP患者规范化的营养支持提供了参考依据.
目的 探討急性胃腸損傷(acute gastrointestinal injury,AGI)分級診治策略在重癥急性胰腺炎(severe acute pancreatitis,SAP)患者營養支持中的應用及對預後的影響.方法 納入的研究對象為2012年1月至2013年12月吉林大學第一醫院ICU收治的SAP患者,診斷標準參照中國急性胰腺炎診治指南(2013年,上海);排除標準:年齡＜18歲、住院時間＜72 h、納入其他試驗研究.共計入選45例SAP患者,依據是否應用AGI分級診治策略而分成AGI分級診治組24例和對照組21例,兩組患者的性彆、年齡和APACHEⅡ評分之間比較差異無統計學意義(P＞0.05).統計和比較兩組患者的住院時間及住院病死率,感染等併髮癥的髮生率,以及腸內營養(enteral nutrition,EN)開始時間和EN達標時間(EN達到目標餵養量時間).計量資料比較採用成組t檢驗或Mann-Whitney U檢驗;計數資料比較採用x2檢驗或Fisher確切概率法檢驗,以P＜0.05為差異具有統計學意義.結果 (1) AGI分級診治組和對照組患者的EN開始時間分彆為2.0(1,2.8)d、5.7 (3.7,9.2)d,兩組比較差異具有統計學意義(Z=-4.149,P＜0.01);AGI分級診治組和對照組患者的EN達標時間分彆為5.5 (3.3,8.8)d、10.4 (8.0,12.5)d,兩組比較差異具有統計學意義(Z=-3.392,P=0.001).(2)比較AGI分級診治組和對照組的肺部感染髮生率,差異有統計學意義(25％ vs57.14％,P=0.028 1);兩組導管相關感染髮生率的差異亦有統計學意義(0％ vs.23.81％,P=0.039 4).(3)比較AGI分級診治組和對照組的住院病死率,差異無統計學意義(16.67％ vs.33.33％,P=0.1943);比較兩組患者住院時間的差異有統計學意義[(23.13±10.58) dvs.(31.10±15.33)d,P=0.046].結論 AGI分級診治策略可使SAP患者在人院後更早接受EN支持和達到目標餵養量,併能夠降低部分感染的髮生率以及縮短住院時間,為臨床SAP患者規範化的營養支持提供瞭參攷依據.
목적 탐토급성위장손상(acute gastrointestinal injury,AGI)분급진치책략재중증급성이선염(severe acute pancreatitis,SAP)환자영양지지중적응용급대예후적영향.방법 납입적연구대상위2012년1월지2013년12월길림대학제일의원ICU수치적SAP환자,진단표준삼조중국급성이선염진치지남(2013년,상해);배제표준:년령＜18세、주원시간＜72 h、납입기타시험연구.공계입선45례SAP환자,의거시부응용AGI분급진치책략이분성AGI분급진치조24례화대조조21례,량조환자적성별、년령화APACHEⅡ평분지간비교차이무통계학의의(P＞0.05).통계화비교량조환자적주원시간급주원병사솔,감염등병발증적발생솔,이급장내영양(enteral nutrition,EN)개시시간화EN체표시간(EN체도목표위양량시간).계량자료비교채용성조t검험혹Mann-Whitney U검험;계수자료비교채용x2검험혹Fisher학절개솔법검험,이P＜0.05위차이구유통계학의의.결과 (1) AGI분급진치조화대조조환자적EN개시시간분별위2.0(1,2.8)d、5.7 (3.7,9.2)d,량조비교차이구유통계학의의(Z=-4.149,P＜0.01);AGI분급진치조화대조조환자적EN체표시간분별위5.5 (3.3,8.8)d、10.4 (8.0,12.5)d,량조비교차이구유통계학의의(Z=-3.392,P=0.001).(2)비교AGI분급진치조화대조조적폐부감염발생솔,차이유통계학의의(25％ vs57.14％,P=0.028 1);량조도관상관감염발생솔적차이역유통계학의의(0％ vs.23.81％,P=0.039 4).(3)비교AGI분급진치조화대조조적주원병사솔,차이무통계학의의(16.67％ vs.33.33％,P=0.1943);비교량조환자주원시간적차이유통계학의의[(23.13±10.58) dvs.(31.10±15.33)d,P=0.046].결론 AGI분급진치책략가사SAP환자재인원후경조접수EN지지화체도목표위양량,병능구강저부분감염적발생솔이급축단주원시간,위림상SAP환자규범화적영양지지제공료삼고의거.
Objective To study the utility of acute gastrointestinal injury (AGI) grading system in the strategy of diagnosis and treatment of severe acute pancreatitis (SAP) in patients for the guidance of nutritional support.Methods Forty-five patients with SAP admitted to the ICU from January 2012 to December 2013 were enrolled for study.The diagnosis of SAP was made as per the 2013 Chinese guideline of dliagnosis and treatment of acute pancreatitis.The patients with aged ＜ 18 years,length of hospital stay ＜72 h,and those included in other experimental study were excluded.The patients were divided into two groups:AGI group (n =24) and control group (n =21).There were no statistically significant differences in age,gender,APACHE Ⅱ between two groups (P ＞ 0.05).The length of hospital stay,in-hospital mortality,the incidence of complications such as infection,the time of starting enteral nutrition (EN) and reaching caloric goal were compared between the two groups.The t test or Mann-Whitney U test was used for continuous variables and x2 test or Fisher exact test was used for categorical variables,and P ＜ 0.05 was considered statistically significant.Results (1) Between two groups,there were statistically significant differences in the time of starting EN (2.0 d vs.5.7 d,Z =-4.149,P ＜0.01) and reaching caloric goal (5.5 d vs.10.4 d,Z =-3.392,P =0.001).(2) Between two groups,there were statistically significant differences in the incidence of pneumonia (25％ vs.57.14％,P =0.028 1) and catheterrelated infection (0％ vs.23.81％,P =0.039 4).(3) Between two groups,there was no statistically significant difference in in-hospital mortality (16.67％ vs.33.33％,P =0.194 3).In addition,there was significant difference in length of hospital stay between two groups (23.13 ± 10.58) d vs.(31.10 ± 15.33) d,P =0.046.Conclusions The diagnosis and treatment strategy based on AGI grading system is associated with earlier initiation of EN and reaching caloric goal,and partly reduces the incidence of infections and shortens the length of hospital stay,in the meantime,provides guidance for the rationale of nutritional support in the patients with SAP.
