早期肠内营养与延迟肠内营养对重症急性胰腺炎患者腹内高压及免疫功能的影响

发布时间：2018-02-21 01:38

本文关键词： 肠道营养重症急性胰腺炎腹内高压免疫活性　出处：《中国全科医学》2016年14期 　论文类型：期刊论文

【摘要】：目的比较早期肠内营养与延迟肠内营养对重症急性胰腺炎(SAP)患者腹内高压及免疫功能的影响。方法选取2013年1月—2014年12月在皖南医学院附属弋矶山医院急诊内科就诊的SAP患者40例,按照随机数字表法将其分为观察组和对照组,各20例。在综合治疗的基础上,观察组患者入院48 h后行肠内营养支持治疗,对照组患者在入院后5 d予肠内营养支持。两组肠内营养支持干预疗程均为2周。分别记录两组治疗前后腹内压(IAP)及腹内高压发生率;检测两组治疗前后血清免疫球蛋白(IgG、IgM、IgA)及外周血T淋巴细胞亚群(CD_3~+、CD_4~+、CD_4~+/CD_8~+)水平;记录两组治疗前后血淀粉酶、体质指数(BMI)及视觉模拟评分(VAS)。结果两组患者治疗前IAP比较,差异无统计学意义(P0.05);治疗后,观察组IAP低于对照组(P0.05);且两组患者IAP均低于同组治疗前(P0.05)。两组患者第1天和第14天腹内高压发生率比较,差异均无统计学意义(P0.05);观察组第7天和第10天腹内高压发生率低于对照组(P0.05)。治疗前,两组患者血清免疫球蛋白IgG、IgM、IgA及外周血T淋巴细胞亚群CD_3~+、CD_4~+、CD_4~+/CD_8~+水平比较,差异均无统计学意义(P0.05);治疗后,观察组血清免疫球蛋白IgG、IgM、IgA及外周血T淋巴细胞亚群CD_3~+、CD_4~+、CD_4~+/CD_8~+水平均高于对照组(P0.05);两组治疗后血清免疫球蛋白IgG、IgM、IgA及外周血T淋巴细胞亚群CD_3~+、CD_4~+、CD_4~+/CD_8~+水平均高于同组治疗前(P0.05)。治疗前,两组血淀粉酶、BMI及VAS比较,差异均无统计学意义(P0.05);治疗后,观察组血淀粉酶、BMI及VAS均低于对照组(P0.05);两组治疗后血淀粉酶、BMI及VAS均较治疗前降低(P0.05)。治疗过程中对照组患者有5例发生不良反应,观察组有3例发生不良反应,两组不良反应发生率比较,差异无统计学意义(χ~2=0.625,P0.05)。结论早期肠内营养可以明显降低SAP患者腹内高压发生率,调节并改善机体的免疫功能,从而改善患者的预后情况。
[Abstract]:Objective to compare the effects of early enteral nutrition and delayed enteral nutrition on abdominal hypertension and immune function in patients with severe acute pancreatitis (SAP). 40 SAP patients, According to the method of random number table, the patients in the observation group were divided into two groups, 20 cases in each group. On the basis of comprehensive treatment, the patients in the observation group received enteral nutrition support therapy 48 hours after admission. The patients in the control group were given enteral nutrition support 5 days after admission. The course of intervention was 2 weeks. The incidence of intraabdominal pressure (IAPs) and intraabdominal hypertension were recorded before and after treatment in both groups. Before and after treatment, the levels of serum immunoglobulin (IgG) and peripheral blood T lymphocyte subsets (CD3 ~ + CD4 ~ / CD8 ~), serum amylase, body mass index (BMI) and visual analogue score (VASA) were measured before and after treatment in both groups. Results IAP was compared between the two groups before and after treatment. After treatment, the IAP of the observation group was lower than that of the control group (P 0.05), and the IAP of the two groups was lower than that of the same group before treatment (P 0.05). The incidence of intraabdominal hypertension in the two groups on the 1st and 14th day was higher than that in the control group. The incidence of intraabdominal hypertension in the observation group was lower than that in the control group on the 7th and 10th day. Before treatment, the levels of serum immunoglobulin IgG titer IgMU IgA and peripheral blood T lymphocyte subgroup CD3 ~ + CD4 ~ + CD4 ~ / CD8 ~ were compared between the two groups. The difference was not statistically significant (P 0.05). The levels of serum immunoglobulin (IgG) IgMU IgMU IgA and peripheral blood T lymphocyte subsets (CD3 ~ CD4 ~ / CD8 ~ +) in the observation group were higher than those in the control group (P0.05), and the levels of serum immunoglobulin (IgG) IgMU IgMMU IgA and peripheral blood T lymphocyte subsets (CD3 ~ CD4 ~ + / CD8 ~) were higher in the observation group than in the control group (P < 0.05), and the levels of CD3 ~ CD4 ~ / CD8 ~ + were higher in the observation group than in the control group (P < 0.05). Before treatment, P0.05. There was no significant difference in serum amylase and VAS between the two groups (P 0.05). The levels of serum amylase and VAS in the observation group were lower than those in the control group (P 0.05), and the levels of serum amylase and VAS in the two groups were lower than those before treatment. During the course of treatment, 5 patients in the control group had adverse reactions, and 3 patients in the observation group had adverse reactions. There was no significant difference in the incidence of adverse reactions between the two groups (蠂 ~ (2 +)) (蠂 ~ (2 +)) 0.625 (P 0.05). Conclusion early enteral nutrition can significantly reduce the incidence of intra-abdominal hypertension in patients with SAP, regulate and improve the immune function of the body, and thus improve the prognosis of the patients.
【作者单位】：皖南医学院附属弋矶山医院;
【分类号】：R576

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