摘要
目的探讨早期肠内营养（EN）加微生态制剂培菲康对重症急性胰腺炎（SAP）患者疗效的影响。方法将2005年1月至2012年10月收治的70例SAP患者按就诊顺序随机分为肠外营养（PN）组（22例）、EN组（25例）、微生态制剂＋EN（P＋EN）组（23例，在EN治疗基础上经鼻饲管注入培菲康4粒，每粒210mg，12h1次）。3组患者均给予抗感染、抑酸以及抑制胰腺分泌等处理。于治疗前1d及治疗7d、14d取静脉血，用酶联免疫吸附试验（ELISA）检测血浆白细胞介素-8（IL-8）、肿瘤坏死因子-α（TNF—α）水平；用生化分析仪检测C-反应蛋白（CRP）、乳酸脱氢酶（LDH）、白细胞计数、血淀粉酶及脂肪酶，同时观察器官功能变化及预后。结果3组患者治疗后血浆IL-8、TNF—α及CRP、LDH、白细胞计数、血淀粉酶、血脂肪酶均较治疗前显著降低，以P＋EN组下降幅度最大，治疗14dP＋EN组血浆IL-8（μg／L）、TNF—α（ng／L）、CRP（mg／L）、血脂肪酶（U／L）、LDH（U／L）水平明显低于PN组、EN组（IL-8：21．00±7．07比48．00±10．32、32．00±9．30，TNF—α：44．3±10．9比132．1±34．1、67．8±22．3．CRP：35．0±12．4比103．24-49．2、63．0±29．2，血脂肪酶：2694-79比670±145、310±78，LDH：21．8±10．3比78．1±37．4、37．9±25．1，P〈0．05或P〈0．01）。P＋EN组和EN组白细胞计数（×10^9/L）明显低于PN组（5．9±3．0、6．3±3．2比9．6±3．0，均P〈O．05），血淀粉酶（U／L）与PN组无差异（211±49、236±52比298±71，P〉0．05）。P＋EN组、EN组、PN组治疗14d胃肠功能评分（分）依次为0．28±0．05、0．43±0．09、0．71±0．11，差异有统计学意义（均P〈0．01）。与PN组、EN组比较，P＋EN组上消化道出血（1例比9例、2例）、胰周感染及脓肿（2例比12例、5例）等并发症发生情况明显减少（均P〈0．01），住院时间（d）明显缩短（10．4±3．9比25．8±6．4、13．4±5．2，均P〈0．01），但3组病死率无统计学差异。结论早期EN加用微生态制剂培菲康治疗SAP，较PN、EN可明显降低患者血浆炎症介质水平，促进胃肠功能恢复，减少感染等并发症，缩短住院时间。
Objective To investigate the curative effect of early entered nutrition （EN） supplemented with probiotics （bifidobacterium） in patients with severe acute pancreatitis （ASP）. Methods Seventy SAP cases admitted from January 2005 to October 2012 were randomly assigned into parenteral nutrition （PN） group （n=22）, EN group （ n = 25 ） and bifidobacterium added EN （P±EN） group （ n = 23 ）. In P±EN group, patients were given their nutrition the same as that of EN, and also probiotics （bifidobacterium, 4 capsules every 12 hours, given through nasal gastric tube, each capsule weighing 210 mg）. The routine treatment including anti-infection and anti-acid agents, and that of inhibition of pancreatic secretion were given, except for the different nutritional interventions in all groups. The blood samples were collected for e same measurements of interleukin-8 （ IL-8 ） and tumor necrosis factor （TNF-α lactic acid dehydrogenase （ LDH ）, white blood cell （ WBC ） count, amylase and lipase by biochemistry assay 1 day before intervention of nutrition, and 7 days and 14 days after intervention. Changes in organ function and outcome were also recorded at the same time points. Results The plasma levels of IL-8, TNF- α , CRP, LDH, WBC count, amylase and lipase were significantly reduced after nutritional intervention compared with their levels on day 1 before intervention in all three groups. The plasma IL-8 （μg/L）, TNF-α （ng/L）, CRP （mg/L）, lipase （U/L）, LDH （U/L） at 14 days after intervention of nutrition in P＋EN group were significantly lower than those in PN group and EN group （IL-8：21.00 ± 7.07 vs. 48.00 ± 10.32, 32.00 ± 9.30; TNF-α ： 44.3 ± 10.9 vs. 132.1 ±34.1, 67.8 ±22.3; CRP： 35.0 ± 12.4 vs. 103.2 ±49.2, 63.0 ±29.2; lipase： 269 ± 79 vs. 670 ± 145, 310 ± 78; LDH： 21.8 ± 10.3 vs. 78.1 ± 37.4, 37.9 ± 25.1, P〈0.05 or P〈0.01 ）. The WBC count （ × 10^9/L） in P±EN group was significantly lower than that in PN group （5.9 ± 3.0, 6.3 ± 3.2 vs. 9.6 ± 3.0, both P〈0.05 ）, but there was no significant difference in amylase between P±EN group and PN group （211 ± 49, 236 ± 52 vs. 298 ± 71, P〉0.05）. The gastrointestinal dysfunction score in P＋EN, EN, PN groups 14 days after nutritional intervention was 0.28 ± 0.05, 0.43 ± 0.09, 0.71 ± 0.11, respectively, with statistically significant differences （all P〈 0.01 ）. Compared with PN and EN groups, the incidence of upper gastrointestinal bleeding （ 1 vs. 9, 2 ）, infection and abscess （2 vs. 12, 5） was lower Call P〈0.01 ）, and hospital day （days） was significantly shortened in P＋EN group （10.4 ± 3.9 vs. 25.8 ± 6.4, 13.4 ± 5.2, both P〈O.O1 ）. There was no significant statistical difference in mortality rate among three groups. Conclusion Our results indicated that early EN with addition of probiotics （bifidobacterium） resulted in significant lowering of the level of pro-inflammatory cytokines, earlier restoration of gastrointestinal function, decrease of complications such as infection, and shortening of hospital day in patients with SAP.
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2013年第4期224-228,共5页
Chinese Critical Care Medicine
基金
海军后勤科研计划项目（CHJ12J026）
