重症急性胰腺炎患者肠内营养的时机选择(1)
摘 要：目的 观察不同时期肠内营养在重症急性胰腺炎患者肠道屏障功能中的作用。方法 2014年1月～2017年7月在我院就诊的110例重症急性胰腺炎患者，按数字随机表法分为两组，每组55例。EEN组为入院24～72 h给予早期肠内营养，EN组入院3～7 d给予肠内营养。观察治疗前、治疗14 d后实验室指标如白细胞计数、血淀粉酶、C-反应蛋白、肿瘤坏死因子的变化；肠黏膜功能指标D-乳酸、血清二胺氧化酶、尿乳果糖/甘露醇值、内毒素的变化；记录肠鸣音恢复时间、肛门排气排便时间及并发症发生率。结果 EEN组患者治疗14 d后较EN组实验室指标、肠黏膜功能指标降低，差异有统计学意义(P<0.05)；EEN组肠鸣音恢复时间、肛门排气排便时间短于EN 组，差异有统计学意义(P<0.05)； EEN组并发症发生率低于EN组，无患者退出及死亡。结论 入院后24～72 h内行肠内营养，有益于受损区域肠上皮细胞的恢复，维护肠黏膜屏障的完整性，降低感染发生率。
关键词：急性胰腺炎；重症；肠内营养；时机
, http://www.100md.com
中图分类号：R576 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.17.024
文章编号：1006-1959(2018)17-0081-03
Abstract：Objective To observe the effect of enteral nutrition on intestinal barrier function in patients with severe acute pancreatitis at different stages.Methods From January 2014 to July 2017，110 patients with severe acute pancreatitis who were treated in our hospital were divided into two groups according to the numerical random table method，with 55 cases in each group.The EEN group received early enteral nutrition for 24 to 72h after admission，and the EN group received enteral nutrition for 3 to 7d after admission. The changes of laboratory indicators such as white blood cell count，blood amylase，C-reactive protein and tumor necrosis factor were observed before treatment and after 14d of treatment；intestinal mucosal function indexes D-lactic acid，serum diamine oxidase，urinary lactulose/mannitol value，endotoxin changes；recorded bowel sound recovery time，anal exhaust defecation time and complication rate.Results After 14d of treatment，the laboratory and intestinal mucosal function indexes in EEN group were lower than those in EN group，the difference was statistically significant(P<0.05)；the recovery time of bowel sounds and the time of anal exhaustion in the EEN group were shorter than those in the EN group，the difference was statistically significant(P<0.05)；the incidence of complications in the EEN group was lower than that in the EN group.No patient withdrew and died.Conclusion Enteral nutrition within 24 to 72h after admission is beneficial to the recovery of intestinal epithelial cells in the damaged area，maintaining the integrity of the intestinal mucosal barrier and reducing the incidence of infection.
, 百拇医药
Key words：Acute pancreatitis；Severe disease；Enteral nutrition；Timing
重癥急性胰腺炎(severe acute pancreatitis，SAP)是消化系统常见的急危重症，病情凶险，进展快，常因并发多器官功能障碍(MODS)、全身炎症反应综合征(SIRS)、腹腔感染导致高死亡率[1]。在SAP患者中，肠黏膜屏障受到多种因素损伤，通透性增加，肠道细菌以及内毒素易通过受损的肠黏膜进入腹腔、血液中，引起腹腔感染以及败血症，引起MODS和SIRS[2]。另外，此病呈高分解、高代谢状态，对营养需求高，极易导致患者营养不良[3]。因此，肠内营养不仅可以为患者提供营养，还可以有效保护肠黏膜屏障，防止细菌移位，减少并发症，改善患者预后[4]。但何时行肠内营养仍存在争议，本文着重探讨不同时期肠内营养对重症胰腺炎患者炎症介质、肠黏膜屏障功能以及预后的影响。, 百拇医药(谢鹏 曹海泉 尚娟 杜宗汉)
关键词：急性胰腺炎；重症；肠内营养；时机
, http://www.100md.com
中图分类号：R576 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.17.024
文章编号：1006-1959(2018)17-0081-03
Abstract：Objective To observe the effect of enteral nutrition on intestinal barrier function in patients with severe acute pancreatitis at different stages.Methods From January 2014 to July 2017，110 patients with severe acute pancreatitis who were treated in our hospital were divided into two groups according to the numerical random table method，with 55 cases in each group.The EEN group received early enteral nutrition for 24 to 72h after admission，and the EN group received enteral nutrition for 3 to 7d after admission. The changes of laboratory indicators such as white blood cell count，blood amylase，C-reactive protein and tumor necrosis factor were observed before treatment and after 14d of treatment；intestinal mucosal function indexes D-lactic acid，serum diamine oxidase，urinary lactulose/mannitol value，endotoxin changes；recorded bowel sound recovery time，anal exhaust defecation time and complication rate.Results After 14d of treatment，the laboratory and intestinal mucosal function indexes in EEN group were lower than those in EN group，the difference was statistically significant(P<0.05)；the recovery time of bowel sounds and the time of anal exhaustion in the EEN group were shorter than those in the EN group，the difference was statistically significant(P<0.05)；the incidence of complications in the EEN group was lower than that in the EN group.No patient withdrew and died.Conclusion Enteral nutrition within 24 to 72h after admission is beneficial to the recovery of intestinal epithelial cells in the damaged area，maintaining the integrity of the intestinal mucosal barrier and reducing the incidence of infection.
, 百拇医药
Key words：Acute pancreatitis；Severe disease；Enteral nutrition；Timing
重癥急性胰腺炎(severe acute pancreatitis，SAP)是消化系统常见的急危重症，病情凶险，进展快，常因并发多器官功能障碍(MODS)、全身炎症反应综合征(SIRS)、腹腔感染导致高死亡率[1]。在SAP患者中，肠黏膜屏障受到多种因素损伤，通透性增加，肠道细菌以及内毒素易通过受损的肠黏膜进入腹腔、血液中，引起腹腔感染以及败血症，引起MODS和SIRS[2]。另外，此病呈高分解、高代谢状态，对营养需求高，极易导致患者营养不良[3]。因此，肠内营养不仅可以为患者提供营养，还可以有效保护肠黏膜屏障，防止细菌移位，减少并发症，改善患者预后[4]。但何时行肠内营养仍存在争议，本文着重探讨不同时期肠内营养对重症胰腺炎患者炎症介质、肠黏膜屏障功能以及预后的影响。, 百拇医药(谢鹏 曹海泉 尚娟 杜宗汉)