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目的探讨早期经鼻空肠内营养在重症急性胰腺炎治疗中的安全有效性。方法回顾分析本院近4年来收治的28例重症急性胰腺炎(SAP)患者,经综合治疗观察症状体征,检测体重、血常规、血清总蛋白、白蛋白、前白蛋白、肝功能、肾功能、电解质(钾、钠)、血糖、淀粉酶、脂肪酶、CRP 和腹部 CT 影像学变化等,判断临床结果。其中营养支持随机分为13例肠内营养(EN)和15例全胃肠外营养(TPN)。结果两组治疗前外周血白细胞计数、肝肾功能等均无显著差异,治疗2～3周后血白细胞和CRP 恢复正常时间 EN 组显著短于 TPN 组(P<0.01),血清白蛋白和前白蛋白水平显著高于治疗前水平(P<0.01和 P<0.001)和 TPN 组治疗后水平(P<0.01和 P<0.001)。结论早期经鼻空肠内营养对重症急性胰腺炎治疗是安全有效的,可促进SAP 患者肝脏蛋白合成,提高血清白蛋白水平和前白蛋白水平,改善 SAP 营养状况,增强肠道黏膜屏障,防止肠内细菌移位,降低机体炎症反应,改善 SAP 的预后。
Objective To investigate the safety and efficacy of early nasal jejunal nutrition in the treatment of severe acute pancreatitis. Methods The 28 patients with severe acute pancreatitis (SAP) treated in our hospital in recent 4 years were retrospectively analyzed. Symptoms and signs, body weight, blood routine, serum total protein, albumin, prealbumin, liver function, renal function , Electrolyte (potassium, sodium), blood glucose, amylase, lipase, CRP and abdominal CT imaging changes, to determine the clinical outcome. Nutritional support was randomly divided into 13 cases of enteral nutrition (EN) and 15 cases of total parenteral nutrition (TPN). Results Before treatment, there was no significant difference in peripheral blood leukocyte count, liver and kidney function. After 2 to 3 weeks of treatment, the levels of white blood cells and CRP returned to normal in EN group were significantly shorter than those in TPN group (P <0.01) Albumin levels were significantly higher than those before treatment (P <0.01 and P <0.001) and after TPN treatment (P <0.01 and P <0.001). Conclusion Early nasal jejunal nutrition is safe and effective for the treatment of severe acute pancreatitis, which can promote the synthesis of liver protein in SAP patients, increase serum albumin level and prealbumin level, improve SAP nutritional status, enhance intestinal mucosal barrier and prevent intestinal Bacterial translocation, reduce the body’s inflammatory response and improve the prognosis of SAP.