连续血液滤过联合早期肠内营养支持对重症胰腺炎患者临床疗效及生活质量的影响
|
摘要
目的探讨连续血液滤过联合早期肠内营养支持对重症胰腺炎患者临床疗效及生活质量的影响。方法采用前瞻性研究方法,选择2015年1月至2017年11月首都医科大学附属北京潞河医院收治的100例行连续血液滤过治疗的重症胰腺炎患者,采用随机数字表法分为观察组和对照组,每组50例。对照组仅采用连续血液滤过治疗,观察组加用早期肠内营养支持。比较两组患者的临床疗效、炎症因子水平、肠道黏膜功能、免疫功能指标,并采用生活质量核心问卷(quality of life questionare core-30,QLO-C30)评价两组患者的生活质量。结果观察组治疗总有效率为92%,明显高于对照组的78%,差异有显著性(χ~2=3.73,P=0.0308);治疗后两组白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、C反应蛋白(C-reactive protein,CRP)及尿乳果糖/甘露醇比值、降钙素原、血浆二胺氧化酶水平均降低,且观察组低于对照组,差异有显著性(P<0.05);治疗后两组免疫功能指标均较治疗前改善,且观察组优于对照组,差异有显著性(P<0.05)。治疗后观察组QLO-C30量表评分明显高于对照组,差异有显著性(P<0.05)。结论在连续血液滤过治疗的基础上给予早期肠内营养支持可减轻炎症反应,改善肠道黏膜功能,增强免疫力,从而提高重症胰腺炎的临床疗效,改善患者生活质量。
Objective To analyze the effect of continuous hemo?ltration combined with early enteral nutrition support on the treatment of patients with severe acute pancreatitis and the QOL score of patients. Method A prospective study was conducted. From January 2015 to November 2017, 100 patients with severe pancreatitis who underwent continuous hemo?ltration in the author's hospital were treated with continuous hemo?ltration. The observation group was treated with early enteral. Nutritional support. The ef?cacy, in? ammatory factor levels, intestinal mucosal function indicators, immune function indicators and quality of life QIL-C30 quality of life scores were compared between the two groups. Result The total effective rate of the observation group was 92.00%, which was lower than that of the control group(78.00%, χ~2=3.73, P= 0.0308). After treatment, the levels of IL-6, TNF-α and CRP were signi?cantly lower in the two groups, and the observation group was lower than the control group. The ratio of urinary fructose/mannitol, procalcitonin and plasma diamine oxidase decreased and was lower than that of the control group; after treatment, the immune function indexes of the observation group improved and were better than the control group; after treatment, the two groups observed QLO-C30 The scores of the scales were higher than those of the control group. The above differences were statistically signi?cant(P<0.05). Conclusion Early enteral nutrition support based on the quality of continuous hemo?ltration can improve the ef?cacy, alleviate in? ammation, improve intestinal mucosal function, improve immune function, and improve patients' quality of life.
Objective To analyze the effect of continuous hemo?ltration combined with early enteral nutrition support on the treatment of patients with severe acute pancreatitis and the QOL score of patients. Method A prospective study was conducted. From January 2015 to November 2017, 100 patients with severe pancreatitis who underwent continuous hemo?ltration in the author's hospital were treated with continuous hemo?ltration. The observation group was treated with early enteral. Nutritional support. The ef?cacy, in? ammatory factor levels, intestinal mucosal function indicators, immune function indicators and quality of life QIL-C30 quality of life scores were compared between the two groups. Result The total effective rate of the observation group was 92.00%, which was lower than that of the control group(78.00%, χ~2=3.73, P= 0.0308). After treatment, the levels of IL-6, TNF-α and CRP were signi?cantly lower in the two groups, and the observation group was lower than the control group. The ratio of urinary fructose/mannitol, procalcitonin and plasma diamine oxidase decreased and was lower than that of the control group; after treatment, the immune function indexes of the observation group improved and were better than the control group; after treatment, the two groups observed QLO-C30 The scores of the scales were higher than those of the control group. The above differences were statistically signi?cant(P<0.05). Conclusion Early enteral nutrition support based on the quality of continuous hemo?ltration can improve the ef?cacy, alleviate in? ammation, improve intestinal mucosal function, improve immune function, and improve patients' quality of life.
引文
[1]陈欧,邱雄,邵泽勇,等.血液透析膜生物相容性及在重症胰腺炎中的应用[J].中国组织工程研究,2016,20(8):1177-1182.
[2]马微微,王彬,李影,等.内镜下逆行胰胆管造影术后并发症的原因分析与护理对策[J].中国医刊,2017,52(1):82-84.
[3]姜启栋,伍长学.不同血液透析膜材料在重症胰腺炎治疗中的生物相容性分析[J].中国组织工程研究,2016,20(47):7106-7111.
[4]Tan C,Ling Z,Huang Y,et al.Dysbiosis of intestinal microbiota associated with inflammation involved in the progression of acute pancreatitis[J].Pancreas,2015,44(6):868-875.
[5]Lee-Felker SA,Felker ER,Kadell B,et al.Use of MDCT to differentiate autoimmune pancreatitis from ductal adenocarcinoma and interstitial pancreatitis[J].AJR Am J Roentgenol,2015,205(1):2-9.
[6]马会玲.护理干预对重症胰腺炎连续血液净化治疗期间并发症的预防作用[J].现代消化及介入诊疗,2016,21(6):912-914.
[7]凌洪.持续血液净化联合糖皮质激素治疗重症胰腺炎并发呼吸窘迫综合征的临床效果研究[J].中国现代普通外科进展,2017,20(6):444-446,450.
[8]王涛,张凡,魏萌,等.持续血液净化治疗对重症胰腺炎合并MODS患者炎症反应状态及靶器官损伤的影响[J].海南医学院学报,2017,23(9):1210-1212,1216.
[9]王银凤,陶晓根,郭伟,等.连续性静脉-静脉血液透析滤过在高脂血症重症胰腺炎治疗中的应用[J].肝胆外科杂志,2017,25(5):342-344.
[10]徐小彭.早期血液滤过对重症胰腺炎的疗效[J].内科急危重症杂志,2017,23(2):153,167.
[11]张莘,王颖.集束化干预在急重症胰腺炎营养支持中的应用[J].河北医药,2016,38(23):3664-3666.
[12]惠亮亮,章向成,王敏,等.三种不同营养支持方式对急性重症胰腺炎的疗效评估[J].徐州医学院学报,2016,36(4):233-236.
[13]郑云丽.老年胃癌患者术后早期肠外联合肠内营养支持对其预后的影响[J].中国老年学杂志,2015,15(19):5519-5521.
[14]刘兵,马笑宇,戴纯刚,等.早期肠内营养支持对颅脑损伤患者免疫状态及细胞因子的影响观察[J].中国现代医学杂志,2015,25(33):75-78.
[15]Oza VM,Skeans JM,Muscarella P,et al.Groove pancreatitis,a masquerading yet distinct clinicopathological entity analysis of risk factors and differentiation[J].Pancreas,2015,44(6):901-908.
[16]包勤文,龚晨,申潇竹,等.肠内营养支持对社区获得性肺炎高龄患者预后的影响[J].医药导报,2017,36(3):292-295.
[17]胡毅,博涛,高文彪,等.早期肠内营养支持对重症急性胰腺炎患者炎症反应和免疫功能的影响[J].中国老年学杂志,2015,35(8):2083-2084.
[18]Lee PJ,Bhatt A,Holmes J,et al.Decreased severity in recurrent versus initial episodes of acute pancreatitis[J].Pancreas,2015,44(6):896-900.
[19]陈建,庞飞.持续血液净化治疗重症胰腺炎合并急性呼吸窘迫综合征的疗效及对血清炎症因子含量的影响[J].中国煤炭工业医学杂志,2015,18(10):1679-1683.
[20]罗育红,张晖,张学艳,等.连续性血液滤过对重症胰腺炎患者的影响[J].中国医药导报,2015,23(18):19-22.
[2]马微微,王彬,李影,等.内镜下逆行胰胆管造影术后并发症的原因分析与护理对策[J].中国医刊,2017,52(1):82-84.
[3]姜启栋,伍长学.不同血液透析膜材料在重症胰腺炎治疗中的生物相容性分析[J].中国组织工程研究,2016,20(47):7106-7111.
[4]Tan C,Ling Z,Huang Y,et al.Dysbiosis of intestinal microbiota associated with inflammation involved in the progression of acute pancreatitis[J].Pancreas,2015,44(6):868-875.
[5]Lee-Felker SA,Felker ER,Kadell B,et al.Use of MDCT to differentiate autoimmune pancreatitis from ductal adenocarcinoma and interstitial pancreatitis[J].AJR Am J Roentgenol,2015,205(1):2-9.
[6]马会玲.护理干预对重症胰腺炎连续血液净化治疗期间并发症的预防作用[J].现代消化及介入诊疗,2016,21(6):912-914.
[7]凌洪.持续血液净化联合糖皮质激素治疗重症胰腺炎并发呼吸窘迫综合征的临床效果研究[J].中国现代普通外科进展,2017,20(6):444-446,450.
[8]王涛,张凡,魏萌,等.持续血液净化治疗对重症胰腺炎合并MODS患者炎症反应状态及靶器官损伤的影响[J].海南医学院学报,2017,23(9):1210-1212,1216.
[9]王银凤,陶晓根,郭伟,等.连续性静脉-静脉血液透析滤过在高脂血症重症胰腺炎治疗中的应用[J].肝胆外科杂志,2017,25(5):342-344.
[10]徐小彭.早期血液滤过对重症胰腺炎的疗效[J].内科急危重症杂志,2017,23(2):153,167.
[11]张莘,王颖.集束化干预在急重症胰腺炎营养支持中的应用[J].河北医药,2016,38(23):3664-3666.
[12]惠亮亮,章向成,王敏,等.三种不同营养支持方式对急性重症胰腺炎的疗效评估[J].徐州医学院学报,2016,36(4):233-236.
[13]郑云丽.老年胃癌患者术后早期肠外联合肠内营养支持对其预后的影响[J].中国老年学杂志,2015,15(19):5519-5521.
[14]刘兵,马笑宇,戴纯刚,等.早期肠内营养支持对颅脑损伤患者免疫状态及细胞因子的影响观察[J].中国现代医学杂志,2015,25(33):75-78.
[15]Oza VM,Skeans JM,Muscarella P,et al.Groove pancreatitis,a masquerading yet distinct clinicopathological entity analysis of risk factors and differentiation[J].Pancreas,2015,44(6):901-908.
[16]包勤文,龚晨,申潇竹,等.肠内营养支持对社区获得性肺炎高龄患者预后的影响[J].医药导报,2017,36(3):292-295.
[17]胡毅,博涛,高文彪,等.早期肠内营养支持对重症急性胰腺炎患者炎症反应和免疫功能的影响[J].中国老年学杂志,2015,35(8):2083-2084.
[18]Lee PJ,Bhatt A,Holmes J,et al.Decreased severity in recurrent versus initial episodes of acute pancreatitis[J].Pancreas,2015,44(6):896-900.
[19]陈建,庞飞.持续血液净化治疗重症胰腺炎合并急性呼吸窘迫综合征的疗效及对血清炎症因子含量的影响[J].中国煤炭工业医学杂志,2015,18(10):1679-1683.
[20]罗育红,张晖,张学艳,等.连续性血液滤过对重症胰腺炎患者的影响[J].中国医药导报,2015,23(18):19-22.