早期经鼻空肠管肠内营养支持联合益生菌对重症急性胰腺炎患者营养状况和肠道黏膜损伤程度的影响
| 作者: |
1何建伟,
1夏小丽,
1田巍巍,
1李跃川,
1李泽民
1 如皋市人民医院消化内科，江苏 如皋 226500 |
| 通讯: |
夏小丽
Email: 1598918712@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2020.11.020 |
摘要
目的：探讨早期经鼻空肠管肠内营养(enteral nutrition，EN)支持联合益生菌对重症急性胰腺炎(severe acute pancreatitis，SAP)患者营养状况和肠道黏膜损伤程度的影响。方法：收集2018年1月至2019年12月收治的120例SAP患者，按简单随机分组方法分为早期EN组(n=60)和常规EN组(n=60)。所有SAP患者在禁饮食、胃肠减压等对症处理基础上接受EN联合益生菌治疗，其中早期EN组在入院48 h内给予EN联合益生菌治疗，常规EN组在入院48~72 h给予EN联合益生菌治疗。比较两组急性生理学与慢性健康状况评分II(APACHE II)、营养指标[前白蛋白(prealbumin，PA)、白蛋白(albumin，ALB)、转铁蛋白(transferrin，TF)]、肠道黏膜损伤程度指标[内毒素、D-乳酸]，并记录两组SAP相关并发症发生率、重症监护病房(ICU)住院时间、总住院时间以及病死率等指标。结果：与本组入院24 h比较，两组入院7 d时APACHE II评分和血清内毒素、D-乳酸水平均有明显下降，血清PA，ALB及TF水平显著升高，差异均有统计学意义(均P<0.05)；与常规EN组入院7 d 比较，早期EN组APACHE II评分和血清内毒素、D-乳酸水平更低，血清PA，ALB及TF水平明显较高(均P<0.05)；两组病死率比较差异无统计学意义(P>0.05)，早期EN组SAP并发症率明显低于常规EN组(P<0.05)，ICU住院时间和总住院时间均显著短于常规EN组(均P<0.05)。结论：早期(入院48 h内)经鼻空肠管EN支持联合益生菌能有效改善SAP患者营养状况，减轻患者肠道黏膜损伤程度，降低SAP并发症风险和缩短患者住院时间。
关键词：
重症急性胰腺炎；早期肠内营养；鼻空肠管；APACHE II评分；营养状况；肠道黏膜损伤程度
Effect of early enteral nutrition via nasojejunostomy combined with probiotics on nutritional status and intestinal mucosal damage in patients with severe acute pancreatitis
CorrespondingAuthor: XIA Xiaoli Email: 1598918712@qq.com
DOI: 10.3978/j.issn.2095-6959.2020.11.020
Abstract
Objective: To investigate the effect of early enteral nutrition (EN) support combined with probiotics on nutritional status and intestinal mucosal damage in patients with severe acute pancreatitis (SAP). Methods: All 120 SAP patients from January 2018 to December 2019 were collected and randomly divided into early EN group (n=60) and conventional EN group (n=60). All SAP patients were treated with EN and probiotics on the basis of diet restriction, gastrointestinal decompression and other symptomatic treatment. The early EN group was given EN combined with probiotics within 48 hours after admission, while the conventional EN group was given EN combined probiotics treatment within 48~72 hours after admission. The acute physiology and chronic health status score II (APACHE II), nutritional indicators [prealbumin (PA), albumin (ALB), transferrin (TF)], intestinal mucosal damage index (endotoxin, D-lactic acid) were compared between the two groups, and the incidence of SAP related complications, ICU hospitalization days, total hospitalization days and mortality were recorded. Results: Compared with 24 hours after admission, APACHE II score, serum endotoxin and D-lactic acid levels of the two groups were significantly decreased, and serum PA, ALB, TF levels were significantly increased, the differences were statistically significant (P<0.05); compared with routine EN group, APACHE II score and serum endotoxin and D-lactic acid levels were lower in early EN group, while serum PA, ALB and TF levels were significantly higher in early EN group (P<0.05);There was no significant difference in mortality between the two groups (P>0.05). The complication rate of sap in early EN group was significantly lower than that in conventional EN group (P<0.05). The length of ICU stay and total length of stay in ICU were significantly shorter than those in conventional EN group (P<0.05). Conclusion: Early (within 48 hours after admission) enteral EN support combined with probiotics can effectively improve the nutritional status of SAP patients, reduce the degree of intestinal mucosal damage, reduce the risk of SAP complications and shorten the length of hospital stay.
Keywords：
severe acute pancreatitis; early enteral nutrition; nasojejunointestinal tract; APACHE II score; nutritional status; intestinal mucosal injury degree