摘要
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，于人院后72h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0．2g／（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±O．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。
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, acidoresistanee, 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. ButEIN is better in improving immune function and the prognosis of patients with severe acute pancreatitis than the EEN.
出处
《中国综合临床》
2013年第9期922-925,共4页
Clinical Medicine of China
基金
黑龙江省科技计划项目（GB07C32501）
