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重症急性胰腺炎营养治疗的策略研究 被引量:6

A study on the strategies of nutritional therapy for severe acute pancreatitis
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摘要 目的 探讨重症急性胰腺炎患者营养治疗的策略.方法 选择208例重症急性胰腺炎患者,采用随机数字表法进行分组,早期肠内营养(EEN)组:于发病72 h内通过鼻空肠管给予肠内营养;晚期肠内营养(LEN)组,于发病6d后通过鼻空肠管给予肠内营养;完全肠外营养(TPN)组.观察各组患者治疗前后相关营养指标、并发症发生情况,评估其疗效和安全性.结果 EEN组67例,LEN组72例,TPN组69例.EEN组和LEN组治疗14d时营养不良发生率均低于TPN组[59.7%(40/67)、58.3%(42/72)比84.1%(58/69)],差异均有统计学意义(P<0.05),但EEN组与LEN组比较差异无统计学意义(P>0.05);三组高脂血症和高糖血症发生率比较差异无统计学意义(P>0.05).三组治疗14 d时血清白蛋白、前白蛋白、视黄醇结合蛋白与治疗前比较差异均有统计学意义(P<0.05).EEN组和LEN组治疗14 d时血清白蛋白、前白蛋白、视黄醇结合蛋白与TPN组比较差异有统计学意义(P<0.05),EEN组与LEN组比较差异无统计学意义(P>0.05).TPN组总感染、腹腔感染、血液感染和继发感染的发生率均高于EEN组和LEN组[62.3%(43/69)比25.4%(17/67)、19.4%(14/72),21.7% (15/69)比4.5% (3/67)、6.9%(5/72),39.1% (27/69)比14.9%(10/67)、11.1%(8/72),33.3%(23/69)比9.0%(6/67)、9.7%(7/72)],差异有统计学意义(P<0.05);三组胰周感染、肺部感染发生率比较差异无统计学意义(P>0.05).LEN组与EEN组总感染和不同感染发生率比较差异无统计学意义(P>0.05).三组各种非感染性并发症发生率比较差异无统计学意义(P> 0.05);LEN组和EEN组的治愈率均优于TPN组[91.0%(61/67)、94.4%(68/72)比81.2%(56/69)],差异均有统计学意义(P<0.05),但LEN组与EEN组比较差异无统计学意义(P>0.05).结论 重症急性胰腺炎患者EEN治疗是安全有效� Objective To investigate the strategies of nutritional therapy for severe acute pancreatitis (SAP) patients.Methods Two hundred and eight patients with SAP were randomly divided into early enteral nutrition (EEN) group,late enteral nutrition (LEN) group and total enteral nutrition (TPN) group.EEN group received enteral nutrition through nasojejunal tube feeding within 72 hours in the course of disease,LEN group received the same treatment after 6 d in the course of disease,TPN group received total enteral nutrition.The index of nutrition,incidence of complication were recorded,efficacy and safety were analyzed.Results EEN group included 67 cases,while 72 cases in LEN group and 69 cases in TPN group.The incidence rate of malnutrition after 14 d of treatment in EEN group and LEN group was significantly lower than that in TPN group [59.7% (40/67),58.3% (42/72) vs.84.1% (58/69),P <0.05],but the difference between EEN group and LEN group was not statistically significant (P > 0.05).There was no statistically significant difference in the incidence of hyperlipidemia and hyperglycemia among three groups (P > 0.05).The expression level of albumin,prealbumin and retinol-binding protein after 14 d of treatment in three groups compared with those before treatment and the differences were statistically significant (P < 0.05).The expression level of albumin,prealbumin and retinol-binding protein after 14 d of treatment in EEN group and LEN group compared with those in TPN group and the differences were statistically significant (P< 0.05),there was no statistically significant difference between EEN group and LEN group (P> 0.05).The incidence rate of total infections,abdominal infections,bloodstream infections,secondary superinfections in TPN group were significantly lower than those in EEN group and LEN group [62.3%(43/69) vs.25.4% (17/67),19.4%(14/72) ;21.7%(15/69) vs.4.5%(3/67),6.9% (5/72);39.1%(27/69) vs.14.9%(10
出处 《中国医师进修杂志》 2013年第26期3-6,共4页 Chinese Journal of Postgraduates of Medicine
关键词 胰腺炎 营养疗法 肠道营养 Pancreatitis Nutrition therapy Enteral nutrition
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