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目的观察经鼻空肠管行肠内营养(EN)联合高容量血液滤过治疗重症急性胰腺炎(SAP)的临床疗效。方法回顾分析2006年6月至2008年12月本科收治的SAP患者72例。其中40例(对照组)行连续高容量血液滤过及全静脉营养(TPN);32例(治疗组)在连续高容量血液滤过治疗及经鼻空肠管肠内营养(EN)治疗,观察两组患者生命体征,测定血液TNF-α、IL-6及内毒素的含量。结果两组治疗后APACHEⅡ评分,血液细胞因子含量均明显降低,治疗前后差异有统计学意义(P<0.05);对照组内毒素的含量于治疗开始后逐渐升高,而治疗组内毒素的含量在治疗短时间内升高后逐渐降低,组间差异有统计学意义P<0.05。结论血液滤过能降低血液炎症介质及细胞因子,经鼻空肠管肠内营养能较好地改善胃肠功能,降低血液内毒素含量,两者早期联合应用能提高SAP的临床疗效。
Objective To observe the clinical efficacy of nasal jejunum enteral nutrition (EN) combined with high-volume hemofiltration in the treatment of severe acute pancreatitis (SAP). Methods Retrospective analysis of 72 cases of SAP patients admitted from June 2006 to December 2008. Forty patients (control group) underwent continuous high-volume hemofiltration and total parenteral nutrition (TPN); 32 patients (treatment group) underwent continuous high-volume hemofiltration and enteral nutrition (EN) Two groups of patients with vital signs, determination of blood levels of TNF-α, IL-6 and endotoxin. Results The APACHEⅡscore and the content of blood cytokines were significantly decreased in both groups before and after treatment (P <0.05). The content of endotoxin in the control group increased gradually after the start of treatment, but the content of endotoxin in the treatment group After treatment for a short period of time increased gradually decreased, the difference between groups was statistically significant (P <0.05). Conclusion Hemofiltration can reduce blood inflammatory mediators and cytokines. Enteral nutrition in the nasogastrointestinal jejunum can improve gastrointestinal function and decrease endotoxin in the blood. The combination of the two can improve the clinical efficacy of SAP.