重症急性胰腺炎穿刺引流术后早期肠内生态免疫营养的应用研究

发布时间：2018-05-26 05:52

本文选题：重症急性胰腺炎 + 生态免疫营养　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:探讨重症急性胰腺炎(SAP)经介入引流后,早期肠内生态免疫营养对患者营养状态、免疫功能、炎症反应和预后方面的临床疗效。方法:选择2012年01月-2014年12月我院收治的35例SAP患者作为研究对象,均符合SAP诊断标准。将35例患者随机分为2组:静脉营养组(PN组,15例)和肠内生态免疫营养组(EEIN组,20例)。PN组接受3L袋的全胃肠外营养;EEIN组的胰腺坏死组织经超声介入穿刺引流内24h,通过内镜引导放置鼻肠营养管行生态免疫营养。2组患者均于治疗前及治疗后7d和14d分别取血测定前白蛋白(PAB)、转铁蛋白(TF);C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6);CD4+、CD8+、CD4+/CD8+的T淋巴细胞亚群;Ig A、Ig G、Ig M免疫球蛋白各项指标。并观察2组患者的腹部症状,统计2组患者感染率、大便菌群失调和中转手术率。结果:1治疗后2组患者的前白蛋白、转铁蛋白均有不同程度升高,EEIN组高于PN组,差异有统计学意义(P0.05);2营养治疗后,2组患者CD4+、CD8+、CD4+/CD8+的T淋巴细胞亚群及免疫球蛋白Ig A逐渐升高,EEIN组高于PN组,差异有统计学意义(P0.05),但Ig G、Ig M差异无统计学意义(P0.05);3营养治疗后,2组患者CRP、IL-6、TNF-α逐渐降低;EEIN组低于PN组,差异有统计学意义(P0.05);4在改善患者的腹部症状,并发感染率、大便菌群失调和中转手术率方面,EEIN组优于PN组,差异均有统计学意义(P0.05)。结论:穿刺引流术能减轻SAP患者的腹部症状,早期肠内生态免疫营养可以改善SAP患者营养代谢和免疫功能,促进消化道功能的恢复,防止细菌移位,减轻炎性反应,其作用优于静脉营养。
[Abstract]:Objective: to investigate the effect of early enteral ecological immune nutrition on nutritional status, immune function, inflammatory reaction and prognosis of patients with severe acute pancreatitis (SAP) after interventional drainage. Methods: 35 patients with SAP admitted in our hospital from January 2012 to December 2014 were selected as study subjects, all of whom were in accordance with the diagnostic criteria of SAP. 35 patients were randomly divided into two groups: intravenous nutrition group (PN group, n = 15) and enteral ecological immune nutrition group (EPI group, n = 20). The pancreatic necrotic tissue of the EEIN group received 3L bag of total parenteral nutrition for 24 hours. Eco-immune nutrition with naso-enteral nutrition tube guided by endoscope. 2 patients in group 2 were treated with EIAN before treatment, 7 days and 14 days after treatment, respectively. The blood samples were taken to determine the levels of prealbumin, transferrin, TFTF-C-reactive protein, tumor necrosis factor- 伪 TNF- 伪, interleukin-6IL-6CD4, CD8 / CD8 and CD4 / CD8 / CD8 respectively. The T lymphocyte subsets of Ig G G G M immunoglobulin. The abdominal symptoms of the two groups were observed, and the infection rate, stool flora imbalance and the rate of conversion to surgery were counted. Results the levels of prealbumin and transferrin in both groups were higher than those in PN group. There was a significant difference in the T lymphocyte subsets and immunoglobulin IgA in CD4 CD8 / CD 4 / CD 8 between the two groups after nutritional therapy. The level of immunoglobulin IgA in EEIN group was higher than that in PN group. The difference was statistically significant (P 0.05), but there was no significant difference between the two groups (P 0.05). After nutrition treatment, the level of CRPIL-6 / TNF- 伪 in the two groups was lower than that in the PN group. The difference was statistically significant (P 0.05) in improving abdominal symptoms and complicated with infection rate. The fecal dysbacteriosis and the rate of conversion to surgery in EEIN group were better than those in PN group, and the difference was statistically significant (P 0.05). Conclusion: puncture and drainage can relieve abdominal symptoms of SAP patients. Early enteral ecological immune nutrition can improve nutritional metabolism and immune function of SAP patients, promote the recovery of digestive tract function, prevent bacterial translocation and alleviate inflammatory reaction. Its effect is superior to intravenous nutrition.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.51

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