重症急性胰腺炎患者营养支持的临床研究
Clinical study on nutrition support in patients with severe acute pancreatitis.
作者信息
Zhao Gang, Wang Chun-You, Wang Fang, Xiong Jiong-Xin
机构信息
Pancreatic Surgery Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China.
出版信息
World J Gastroenterol. 2003 Sep;9(9):2105-8. doi: 10.3748/wjg.v9.i9.2105.
AIM
To investigate the effect of nutritional support therapy on severe acute pancreatitis (SAP).
METHODS
A total of 96 patients with severe acute pancreatitis were divided randomly into control and treatment groups. The former group received total parenteral nutrition (TPN) via central venous infusion, while parenteral nutrition (PN) and enteral nutrition (EN) therapies were applied in different phases for the latter group. The nutrition status, acute phase responses, pancreas lesions, enteric mucosa penetrability and immune functions were monitored.
RESULTS
Body weight and prealbumin concentration were increased in treatment group, compared to those in the control group, but albumin concentration did not change significantly. Acute physiology and chronic health evaluation II (APACHE II) scores decreased after 7 d of treatment, whereas the scores of the control group decreased on the 11(th) day. Concentrations of tumor necrosis factor-alpha (TNF-alpha), interleukine-6 (IL-6) and serum C reactive protein (CRP) dropped earlier in the treatment group (on the 4(th) day) than that in the control group (on the 7(th) day). No difference was observed in pancreatic lesions between the control and treatment groups. Concentration of endotoxin and lactulose/manicol (L:M) ratio of urine did not change in treatment group, but those in the control group were elevated markedly. Compared with the treatment group, CD4:CD8 T cells ratio and immunoglobulin G (IgG) concentration in the control group decreased significantly.
CONCLUSION
Compared to TPN, the combined therapy of EN and PN could improve the nutrition status and moderate the acute phase response obviously. Moreover, the integrity of enteric mucosa and immune function were protected more effectively in treatment group than in the control one. On the other hand, EN did not simulate the excretion of pancreas and avoid exaggerating the inflammation of pancreas. Thus, appropriate application of PN and EN appears to be more effective for patients with SAP.
目的
探讨营养支持治疗对重症急性胰腺炎（SAP）的影响。
方法
将96例重症急性胰腺炎患者随机分为对照组和治疗组。对照组通过中心静脉输注接受全胃肠外营养（TPN），而治疗组在不同阶段采用肠外营养（PN）和肠内营养（EN）治疗。监测营养状况、急性期反应、胰腺病变、肠黏膜通透性和免疫功能。
结果
与对照组相比，治疗组体重和前白蛋白浓度升高，但白蛋白浓度无明显变化。治疗7天后急性生理与慢性健康状况评分系统II（APACHE II）评分下降，而对照组在第11天评分下降。治疗组肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）和血清C反应蛋白（CRP）浓度在第4天比对照组（第7天）更早下降。对照组和治疗组胰腺病变无差异。治疗组内毒素浓度和尿乳果糖/甘露醇（L:M）比值无变化，但对照组明显升高。与治疗组相比，对照组CD4:CD8 T细胞比值和免疫球蛋白G（IgG）浓度明显降低。
结论
与TPN相比，EN和PN联合治疗可明显改善营养状况并减轻急性期反应。此外，治疗组比对照组更有效地保护了肠黏膜完整性和免疫功能。另一方面，EN不会刺激胰腺分泌，避免加重胰腺炎症。因此，对SAP患者适当应用PN和EN似乎更有效。
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