| 陈国栋，贺更生，黄秋林，罗加兴，曹金敏，文武.不同营养方式治疗重症急性胰腺炎患者预后的比较.[J].中南医学科学杂志.,2013,41(1):38-42. |
| 不同营养方式治疗重症急性胰腺炎患者预后的比较 |
| Comparison of Different Nutritional Therapy on the Prognosis of Patients With Severe Acute Pancreatitis |
| 投稿时间：2012-09-19 |
| DOI： |
| 中文关键词: 重症急性胰腺炎 早期肠内营养 肠外营养 预后 |
| 英文关键词:severe acute pancreatitis early enteral nutrition parenteral nutrition prognosis |
| 基金项目:湖南省科学技术厅科技计划(2012FJ3105). |
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| 中文摘要: |
| 目的探讨肠外营养（PN）、早期肠内营养（EEN）联用早期肠外营养（EPN）或其联用晚期肠外营养（LPN）对重症急性胰腺炎（SAP）患者临床预后的影响。方法150例SAP患者随机平均分为3组。50例患者全程应用PN为PN组，EEN+EPN组（早期）的50例患者在入院后的48 h内开始PN，而EEN+LPN组（晚期）的50例患者于入院8天后开始PN，后两组均按相同方案开展EEN支持。比较各组血生化指标、C反应蛋白（CRP）水平、并发症以及住院情况。结果出院与入院比，EEN组白蛋白（ALB）、总淋巴细胞计数（TLC）、血糖（BS）、血钙（Ca）及CRP水平均有明显好转（P<0.05），而PN组只有CRP明显好转（P<0.05）。出院时组间相互比较，EEN组ALB、TLC、BS、Ca及CRP较PN组明显好转（P<0.05），其中EPN+EEN组ALB较LPN+EEN组回升高些（P<0.05），而LPN+EEN组BS恢复好些（P<0.05）。相对PN组，EEN组平均住院天数及ICU停留时间明显缩短（P<0.05），出现消化道不良反应相对减少，而EPN+EEN与LPN+EEN两组之间差异无显著性。EEN组在发生肠功能衰竭（中重度）、腹腔高压及脓毒血症几率方面显著低于PN组（P<0.05），而EPN+EEN组及LPN+EEN组之间差异不明显。结论对SAP患者尽可能给予EEN，而在给予EEN的同时，实施EPN与LPN对SAP患者的预后无明显差异。 |
| 英文摘要: |
| ObjectiveTo evaluate the impact of parenteral nutrition (PN),early enteral nutrition (EEN) associated with early parenteral nutrition (EPN) and late parenteral nutrition (LPN) support on clinical outcomes in patients with severe acute pancreatitis (SAP).Methods150 patients were prospectively randomized to three groups.In 50 patients,PN was always initiated；In other 50 patients,PN was initiated within 48 hours after admission (early-initiation group),whereas in the last 50 patients,parenteral nutrition was not initiated before day 8 (late-initiation group).A protocol for the early initiation of enteral nutrition was applied to both groups.ResultsComparing discharge and admission,ALB,TLC,BS,Ca and CRP at admission of EEN group were significantly improved (P<0.05),but only for CRP of PN group.Compared between discharged groups,ALB,TLC,BS,Ca and CRP of EEN group significantly improved compared with the PN group (P<0.05).ALB of the EPN+EEN group rebounded higher than LPN+EEN group(P<0.05),while BS was on the contrary.The average days of hospitalization and ICU stay were significantly shorter in the EEN group than PN group (P<0.05).The gastrointestinal adverse of EEN group relatively reduced compared with the PN group,while there was no significant difference between EPN+EEN and LPN+EEN groups.The intestinal function failure (moderate to severe),abdominal hypertension and sepsis probability was significantly lower in EEN group than the PN group (P<0.05),but the difference of complication probability was not obvious between EPN+EEN group and LPN+EEN group.ConclusionSAP patients were provided with EEN as far as possible,there is no significant difference of SAP prognosis with Late initiation of parenteral nutrition,as compared with early initiation. |
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