超早期肠内营养对重症急性胰腺炎预后影响的回顾性研究

发布时间：2018-06-30 07:00

  本文选题：重症胰腺炎 + 肠内营养　； 参考：《浙江大学》2017年硕士论文

【摘要】：重症急性胰腺炎约占急性胰腺炎的5%--10%,病情凶险,死亡率高达30%--50%。治疗方式主要为禁食、补液、脏器功能支持、抑制胰腺分泌、营养支持、并发症治疗等。其中,营养支持成为治疗重症胰腺炎的一个重要环节。营养方式分为肠内营养与肠外营养。在过去,首先推荐肠外营养,认为可使胰腺处于"休息"状态,减少胰腺外分泌,减轻胰腺自身消化程度。近年来,肠内营养地位逐年上升,研究认为可以减少感染率。相关指南首先推荐肠内营养,一般在入院3-5天内需开始,最晚不超过1周。若对肠内营养不能耐受或有禁忌症,可考虑肠外营养代替。关于更早进行肠内营养(48小时内)能否获得更大收益,目前仍有争议。方法:选择2013年1月1日至2016年9月30日入住邵逸夫医院重症急性胰腺炎患者48人,按照入院后肠内营养(通过鼻空肠管输注百普力营养液)开始时间,分为超早期营养组(入院48小时内开始)和普通早期组(入院48小时至7天内开始),通过比较两组患者的住院时间、6个月内并发症(脏器功能衰竭、假性囊肿、消化道瘘、胰周血管并发症)、28天死亡率、6个月死亡率、感染相关指标、白蛋白水平情况,探讨超早期肠内营养(48小时内)对重症急性胰腺炎预后的影响。结果:治疗前,两组患者男女比例分别为10/7和14/17,年龄分别为49.53±14.69岁和53.94±9.68岁,APCHE Ⅱ评分分别为14.47±6.26分和14.26±5.18分,病因中胆源性比例分别为59%和68%,高脂血症性比例分别为29%和13%,其他原因(酒精性、ERCP术后引起)比例分别为12%和19%,各组间比较P值均大于0.05;治疗后,两组平均住院时间分别为24.12±14.38天和27.71±25.34天(P0.05),其中肾功能衰竭人数分别为3人(18%)和3人(10%)(P0.05),呼吸衰竭人数分别为8人(47%)和18人(58%)(P0.05),出现假性囊肿人数分别为8人(47%)和13人(42%X P0.05),出现消化道瘘人数分别为0人(0%)和2人(6%X P0.05),出现胰周血管并发症人数分别为2人(12%)和2人(6%)(P0.05),28天死亡率分别为12%和3%(P0.05),6个月死亡率分别为18%和6%(P0.05),差异无统计学意义。24小时内CRP水平分别为161.13±126.82mg/L和116.28±102.94mg/L(P0.05),CRP 最高值水平分别为 295.68±69.53mg/L 和 248.26±75.31mg/L(P0.05),2 周时 CRP 分别为 78.00±90.70mg/L 和 61.25±63.16mg/L(P0.05),出现肺部感染6%和10%(P0.05),菌血症分别为12%和13%(P0.05),胰腺坏死分别为0%和19%(P0.05),入院后24小时内白蛋白水平分别为35.31±6.36g/L和 35.67±7.22g/L(P0.05),2 周时白蛋白水平分别为 33.00±6.08g/L 和 34.19±4.46g/L(P0.05),ΔALB 分别为 2.30±8.14g/L 和 1.47±8.55g/L(P0.05),开放饮食时间分别为 16.58±5.07 天和 14.22±8.27 天(P0.05)。结论:根据本回顾性分析结果,对重症急性胰腺炎患者,相对于普通早期肠内营养(入院48小时后至7天),超早期肠内营养(入院48小时内)对急性重症胰腺炎的预后并无明显的影响。
[Abstract]:Severe acute pancreatitis accounts for about 5-10 percent of acute pancreatitis, the disease is dangerous, the death rate is as high as 30-50. The main treatment methods were fasting, fluid rehydration, organ function support, pancreatic secretion inhibition, nutritional support, complications treatment and so on. Among them, nutritional support has become an important link in the treatment of severe pancreatitis. Nutrition is divided into enteral nutrition and parenteral nutrition. In the past, parenteral nutrition was first recommended as a way to "rest" the pancreas, reduce exocrine secretion and reduce the degree of pancreatic autodigestion. In recent years, the status of enteral nutrition has increased year by year. The guidelines first recommend enteral nutrition, usually starting with 3-5 days of hospitalization and no later than 1 week. If enteral nutrition is intolerable or contraindicated, parenteral nutrition may be considered instead. There is still debate about the benefits of early enteral nutrition (within 48 hours). Methods: from January 1, 2013 to September 30, 2016, 48 patients with severe acute pancreatitis admitted to run Shaw Hospital were enrolled in the study. The patients were divided into two groups: the ultra-early nutrition group (starting within 48 hours of admission) and the general early group (starting within 48 hours to 7 days of admission). By comparing the length of stay, the complications within 6 months (organ failure, pseudocyst, gastrointestinal fistula) were compared between the two groups. The mortality rate of 28 days, 6 months mortality, infection related index, albumin level, and the effect of super early enteral nutrition (within 48 hours) on the prognosis of severe acute pancreatitis were investigated. Results: before treatment, the ratio of male to female was 10 / 7 and 14 / 17, and the age was 49.53 卤14.69 years old and 53.94 卤9.68 years old respectively. The scores of APCHE 鈪，

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