三腔鼻空肠管早期肠内营养对重症急性胰腺炎疗效的影响

发布时间：2018-03-22 07:43

  本文选题：重症急性胰腺炎　切入点：肠内营养　出处：《天津医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察鼻胃管与三腔鼻空肠管肠内营养(enteral nutrition,EN)支持对重症急性胰腺炎(severe acute pancreatitis,SAP)患者炎症指标、耐受性和预后的影响,探讨三腔鼻空肠管早期EN对SAP的营养支持意义。方法:选取2014年1月至2016年12月急诊ICU收治的68例SAP患者,随机分成三腔鼻空肠管EN组(观察组)36例和鼻胃管EN组(对照组)32例。入院后观察组患者立即置入三腔鼻空肠管,对照组患者立即置入鼻胃管,两组患者均给予相同的基础治疗。在此基础上,血流动力学相对稳定,胃肠功能恢复时立即开始EN。观察指标:记录所有患者一般临床资料,并于入院时取血测定血液生化、常规等实验室指标,计算入院时APACHE II评分、MCTSI评分。在治疗后第1、3、5、7、14天再次计算APACHEⅡ评分。记录EN开始时间和到达全量时间。测定入院时和治疗第7天的前白蛋白水平。于入院时和第3、7天测定血清C-反应蛋白水平以及入院时和治疗第7天的血清TNF-α、IL-6水平。记录患者腹胀/腹痛缓解时间,观察并记录EN期间胃潴留、返流、腹泻,和腹痛加重的情况。最后总结总有效率、病死率,以及ICU住院时间。所有数据建立数据库,应用SPSS20.0软件进行统计分析。结果1)一般资料比较两组患者的性别构成、年龄、入院时的发病时间、主要病因构成等一般资料的差异无统计学意义(P0.05)。入院时病情程度:观察组和对照组入院时的APACHEⅡ评分分别是9.22±3.48、9.25±3.11,MCTSI评分为4.56±1.48、4.69±1.49,差异无统计学意义(P0.05)。2)EN开始和全量时间观察组EN开始时间为2.56±1.23天,对照组为3.59±1.27天,经t检验,差异显著(P=0.001),观察组EN到达全量的时间为7.36±2.70天,对照组为8.78±2.86天,差异有统计学意义(P0.05)。3)两组患者APACHEⅡ评分变化比较观察组和对照组在治疗第1天的APACHEⅡ分别为6.17±3.26、7.53±4.47,第3天分别为3.53±1.7、5.9±4.09,第5天分别为2.25±1.7、4.31±3.29,第7天分别为2.14±2.51、2.47±2.92,第14天分别为1.53±3.46、1.53±2.9。组内比较在治疗的前7天差异有统计学意义(P0.05),两组间比较在第3天、第5天差异有统计学意义(P0.05)。4)炎症指标变化入院时观察组与对照组的CRP水平为127.6±74.3mg/L、131.2±82.2mg/L,治疗后第1天116.7±74.49mg/L、127.9±82.1mg/L,第3天68.8±55.1mg/L、75.2±60.4mg/L,第7天的31.5±29.7mg/L、35.3±31.4mg/L,两组CRP水平均呈下降趋势,组内比较差异有统计学意义(P0.05),但两组间比较差异无统计学意义(P0.05);入院时观察组和对照组的TNF-α水平分别为37.16±8.07pg/ml、37.28±7.78pg/ml,IL-6水平分别为1.81±12.32pg/ml、81.64±12.23pg/ml,治疗后第7天TNF-α分别为25.32±7.27pg/ml、27.36±7.27pg/ml,IL-6为56.02±12.49pg/ml、57.72±12.79pg/ml。治疗前后两组的TNF-α和IL-6水平均有显著改善(P0.05),组间比较无统计学意义(P0.05)。5)营养评估入院时观察组和对照组的PA值分别为128.5±31.1g/L、134.4±38.3g/L,治疗第7天观察组PA值为189.1±23.9g/L,对照组PA值为174.58±27.7g/L,均较入院升高,组内比较差异显著(P0.01),组间比较入院时PA值差异无统计学意义(P0.05),治疗第7天观察组PA值更高,差异有统计学意义(P0.05)。6)急性胰腺炎症状和实验室指标变化腹胀/腹痛缓解时间观察组较对照组分别为55.22±18.93小时,73.88±23.43小时,差异有统计学意义(P0.05)。EN的并发症发生率两组分别为:6例和12例(P0.05),胃潴留/返流的发生率观察组为1例,对照组7例(P0.01),腹泻的发生率观察组2例,对照组3例(p0.05),腹痛/腹胀加重的发生率观察组3例,对照组2例(P0.05)。7)临床效果比较观察组和对照组的总有效率分别是80.55%和78.12%,差异无统计学意义(P0.05);两组死亡人数分别是观察组1例、对照组2例,差异无统计学意义(P0.05)。ICU住院时间两组分别为8.56±3.47天、10.5±3.93天,差异有统计学意义(P0.05)。结论:1.三腔鼻空肠管EN支持能更快缓解SAP的临床症状、改善病情,缩短ICU住院时间。2.三腔鼻空肠管较鼻胃管更加安全,发生返流/胃潴留的风险更低,有临床推广价值。3.三腔鼻空肠管和鼻胃管途径EN对于SAP疗效和预后影响相当。
[Abstract]:Objective: To observe the three cavity nasogastric tube and nasojejunal tube enteral nutrition (enteral, nutrition, EN) on severe acute pancreatitis (severe acute, pancreatitis, SAP) inflammation index, effects of tolerance and prognosis, to investigate the three cavity nasointestinal tube nutrition support for SAP EN. Methods: 68 cases of SAP from January 2014 to December 2016 with emergency ICU were randomly divided into three cavities, nasojejunal tube EN group (observation group) 36 cases and nasogastric tube group EN (control group) 32 cases. The observation immediately placed three cavity nj-en groups of patients after admission, patients in the control group, nasogastric tube, two groups of patients were given the same basic treatment. On this basis, relatively stable hemodynamics, recovery of gastrointestinal function immediately began EN. outcome measures: the records of all patients with clinical data and blood samples were collected from the hospital routine determination of blood biochemical, and other laboratory parameters, calculation of admission AP ACHE II score, MCTSI score. APACHE score calculated again in the first 1,3,5,7,14 days after treatment. EN recording start time and reaches full amount of time. Measured at admission and seventh days of treatment. The level of prealbumin on admission and day 3,7 measured the levels of serum C- reactive protein and admission and seventh days of treatment serum TNF- alpha, the level of IL-6. Record the patients in remission time of abdominal pain / abdominal distension, observe and record EN during gastric retention, reflux, diarrhea, abdominal pain and worsening. Finally, the total efficiency, mortality, and hospitalization in ICU. All data should establish a database, using SPSS20.0 software for statistical analysis. Results of the 1 general sex) the data were compared between the two groups of age, the onset time of admission, no significant difference was found in the etiology of general data (P0.05). At the time of admission severity: observation group and control group at the time of admission APACHE score Were 9.22 + 3.48,9.25 + 3.11, MCTSI score was 4.56 + 1.48,4.69 + 1.49, there was no statistically significant difference (P0.05).2) EN start and total time of the observation group EN start time was 2.56 + 1.23 days, the control group was 3.59 + 1.27 days, by t test, significant differences were observed in group EN (P=0.001). To the full amount of time was 7.36 + 2.70 days, the control group was 8.78 + 2.86 days, the difference was statistically significant (P0.05).3) group and control group in APACHE first days of treatment II were 6.17 + 3.26,7.53 + 4.47 comparison of two groups were observed in patients with APACHE score changes, third days were 3.53 + 1.7,5.9. 4.09, fifth days were 2.25 + 1.7,4.31 + 3.29, seventh days were 2.14 + 2.51,2.47 + 2.92, fourteenth days were 1.53 + 3.46,1.53 + 2.9. group compared with 7 days before treatment difference was statistically significant (P0.05), between the two groups in third days, fifth days was statistically significant difference (P0.05.4)) and inflammatory indexes Admission to the observation group and the control group CRP was 127.6 + 74.3mg/L, 131.2 + 82.2mg/L, first days after treatment was 116.7 + 74.49mg/L, 127.9 + 82.1mg/L, third days and 68.8 + 55.1mg/L, 75.2 + 60.4mg/L, seventh days, 31.5 + 29.7mg/L, 35.3 + 31.4mg/L, CRP levels of the two groups were decreased, compared within the group the difference was statistically significant (P0.05), but there was no significant difference between the two groups (P0.05); admission TNF- level in the observation group and the control group were 37.16 + 8.07pg/ml, 37.28 + 7.78pg/ml, IL-6 levels were 1.81 + 12.32pg/ml, 81.64 + 12.23pg/ml, seventh days after treatment were 25.32 + alpha TNF- 7.27pg/ml, 27.36 + 7.27pg/ml, IL-6 = 56.02 + 12.49pg/ml, 57.72 + 12.79pg/ml. before and after treatment of the two groups of TNF- alpha and IL-6 water average was significantly improved (P0.05), no statistical significance between the two groups (P0.05).5) nutritional assessment on admission control group and the observation group PA values were 128 .5卤31.1g/L,134.4卤38.3g/L,娌荤枟绗，

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