整蛋白与短肽制剂在重症急性胰腺炎患者营养支持中的应用

发布时间：2018-06-06 22:33

本文选题：重症急性胰腺炎 + 早期鼻空肠营养　；参考：《山东中医药大学》2015年硕士论文

【摘要】：目的:探讨早期鼻空肠营养给予整蛋白制剂与短肽制剂治疗急性重症胰腺炎的对比分析;探讨早期胃肠功能复苏联合早期肠内营养支持治疗SAP的临床价值。方法:本研究选取千佛山医院ICU 50例SAP病例进行回顾性分析,分为整蛋白制剂组(治疗组)25例,短肽制剂组(对照组)25例。分别检测患者营养支持治疗前与营养支持治疗2周后的评分指标、营养指标、胃肠功能恢复指标、各项感染指标及预后指标等的变化,并对治疗组与对照组各项指标进行对比分析。探讨早期鼻导管空肠营养给予整蛋白制剂与短肽制剂对急性重症胰腺炎患者治疗的对比分析,观察早期肠内营养开启时间,探讨整蛋白制剂与短肽营养制剂对SAP患者预后有无明显差异。结果:在胃肠功能恢复方面,治疗组腹内压测定均明显小于对照组,P0.05,有统计学意义;评分指标方面,经独立样本t检验APACHEII评分、SOFE评分P0.05有明显差异,有统计学意义;营养风险评分、CT严重程度两项指标P0.05无明显差异;感染指标方面,治疗组和对照组感染指标白细胞计数、PCT、血淀粉酶含量三项指标经独立样本t检验P0.05无明显差别。表明给予重症急性胰腺炎患者整蛋白制剂及短肽制剂对患者感染指标的降低无明显差别;并发症方面,经Fisher确切概率法检验,治疗组的胃肠道并发症明显少于对照组,P0.05,有统计学意义;对照组与治疗组代谢并发症经Fisher确切概率法检验,P0.01,两组有明显差异,表明治疗组代谢并发症明显少于对照组。但治疗组与对照组机械并发症与感染并发症经检验,P0.05,两组无明显差异;营养指标方面,治疗组与对照组白蛋白、前白蛋白经独立样本t检验,P0.05,无统计学意义;但治疗组急性时相铁蛋白明显低于对照组,P0.01,有显著差异。结论:1.SAP患者早期鼻空肠给予整蛋白制剂与短肽营养制剂相比,整蛋白制剂能明显降低SAP患者胃肠道并发症发生率,特别是腹内压测定方面。两种制剂均能改善患者临床症状,整蛋白制剂能更快促进APACHEII评分、SOFE评分指标恢复正常。2.SAP患者早期鼻空肠给予整蛋白制剂与短肽营养制剂相比,两者在肠内营养开启时间方面、营养指标白蛋白及前白蛋白增高方面无明显差异,两者在28天病死率及ICU住院时间等预后指标方面无明显差异,两者在CT评分及感染指标方面无明显差异。3.整蛋白制剂含有更多的谷氨酰胺,在提高重症胰腺炎患者免疫力,改善机体代谢、氮平衡,促进蛋白质合成,增加淋巴细胞总数等方面较短肽营养制剂有优势,利于改善重症急性胰腺炎患者的预后。
[Abstract]:Objective: to explore the clinical value of early gastrointestinal resuscitation combined with early enteral nutrition in the treatment of SAP. Methods: 50 cases of SAP in ICU of Qianfushan Hospital were retrospectively analyzed and divided into treatment group (25 cases) and short peptide group (25 cases). The scores, nutritional indexes, gastrointestinal function recovery index, infection index and prognosis index were measured before and 2 weeks after nutritional support treatment, respectively. The indexes of treatment group and control group were compared and analyzed. To investigate the effect of early nasal catheter jejunal nutrition on patients with severe acute pancreatitis (SAP) and to observe the opening time of early enteral nutrition. To investigate the difference of prognosis between whole protein preparation and short peptide nutrition preparation in SAP patients. Results: in the recovery of gastrointestinal function, the intraabdominal pressure in the treatment group was significantly lower than that in the control group (P 0.05), and in the scoring index, there was a significant difference in Apache II score and SOFE score (P0.05) by independent sample t-test. There was no significant difference between the two indexes of nutritional risk score and CT severity (P0.05). In terms of infection index, there was no significant difference between treatment group and control group in leukocyte count (PCT) and serum amylase content (P 0.05) by independent sample t test (P0.05). The results showed that there was no significant difference in the reduction of infection index between the whole protein preparation and the short peptide preparation in the patients with severe acute pancreatitis, and the exact Fisher probability method was used to test the complications. The gastrointestinal complications in the treatment group were significantly lower than those in the control group (P 0.05), and the metabolic complications in the control group and the treatment group were tested by Fisher exact probability test (P 0.01), indicating that the metabolic complications in the treatment group were significantly lower than those in the control group. However, there was no significant difference in the mechanical complications and infection complications between the treatment group and the control group (P 0.05), but there was no significant difference in nutritional indexes between the treatment group and the control group (P 0.05), the albumin and prealbumin in the treatment group and the control group were tested by independent sample t test (P 0.05). But the acute phase ferritin in the treatment group was significantly lower than that in the control group (P 0.01). Conclusion: 1. Early naso-jejunal administration of integral protein preparation in SAP patients can significantly reduce the incidence of gastrointestinal complications, especially in the measurement of intra-abdominal pressure, compared with short peptide nutrition preparation. Both of the two preparations could improve the clinical symptoms of the patients, and the whole protein preparation could accelerate the recovery of Apache II score and SOFE score. 2. Compared with the short peptide nutrition preparation, the whole protein preparation in early naso-jejunal administration of SAP patients had a significant effect on the enteral nutrition opening time. There was no significant difference in nutritional index, albumin and prealbumin, but there was no significant difference in mortality of 28 days and ICU hospitalization time between them. There was no significant difference in CT score and infection index between them. The whole protein preparation contains more glutamine, which has advantages in improving immunity, improving metabolism, nitrogen balance, promoting protein synthesis, increasing the total number of lymphocytes and so on in patients with severe pancreatitis. It is beneficial to improve the prognosis of patients with severe acute pancreatitis.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R576

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