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目的:比较肠内营养(EN)及肠外营养(PN)支持治疗重症急性胰腺炎(SAP)的临床效果。方法:依据随机数字表将57例SAP患者随机分为肠外营养组和肠内营养组,分析营养支持后1、2周的营养状况、免疫学指标,同时比较多器官功能失调综合征(MODS)、胰腺及胰周感染率、病死率及平均住院日和住院费用。治疗2周后行APACHE II评分和CT评分。结果:给予营养支持后,两组血清白蛋白、血红蛋白显著升高,血淀粉酶明显降低(P<0.05);治疗2周时EN组的CRP和WBC均低于PN组(P<0.05);EN组治疗1周后TNF-α、IL-6和IL-1β的水平低于PN组(P<0.05),而PN组到入院2周才有显著降低。MODS、胰腺及胰周感染率、病死率及平均住院日和住院费用、APACHE II评分、CT评分显著降低,EN组均低于PN组(P<0.05)。结论:对于适合给予EN的SAP患者,尽早给予EN较PN有更好的临床治疗效果。EN能够改善重症急性胰腺炎患者的营养状况及预后,缩短住院时间,降低住院费用。
Objective: To compare the clinical effects of enteral nutrition (EN) and parenteral nutrition (PN) in the treatment of severe acute pancreatitis (SAP). Methods: According to the random number table, 57 patients with SAP were randomly divided into parenteral nutrition group and enteral nutrition group. Nutritional status and immunological indexes were analyzed after 1 and 2 weeks of nutritional support. Simultaneous comparison of multiple organ dysfunction syndrome (MODS ), Pancreas and peripancreas infection rate, fatality rate and average length of stay and hospitalization expenses. After 2 weeks of treatment, APACHE II score and CT score were performed. Results: Serum albumin and hemoglobin were significantly increased and serum amylase was significantly decreased in both groups (P <0.05). CRP and WBC in EN group were lower than those in PN group at 2 weeks after treatment (P <0.05). The levels of TNF-α, IL-6 and IL-1β in EN group were lower than those in PN group (P <0.05), while those in PN group decreased significantly after 2 weeks of admission. MODS, pancreas and peripancreas infection rate, mortality and average length of hospital stay and hospitalization costs, APACHE II score and CT score were significantly lower in EN group than in PN group (P <0.05). CONCLUSIONS: Early EN is better than PN for clinical outcomes in SAP patients who are eligible for EN. EN can improve the nutritional status and prognosis of patients with severe acute pancreatitis, shorten the hospital stay and reduce the cost of hospitalization.