老年重症急性胰腺炎早期营养支持治疗
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摘要
目的探讨老年重症急性胰腺炎早期营养支持治疗方法及效果。方法 58例年龄>60岁重症急性胰腺炎患者,根据营养支持治疗方法分为肠内营养(enteral nutrition, EN)组25例和完全肠外营养(total parenteral nutrition, TPN)组33例,比较2组治疗前和治疗1个月后体质量指数、血红蛋白、血清白蛋白和前白蛋白水平,并采用APACHEⅡ和Ranson评分评估营养状况;随访6个月,比较2组并发症发生率。结果治疗前,2组体质量指数、血红蛋白、血清白蛋白、前白蛋白水平及APACHEⅡ和Ranson评分比较差异均无统计学意义(P>0.05);治疗1个月后,EN组体质量指数[(21.13±3.12)kg/m~2]、血红蛋白[(135.42±29.52)g/L]、血清白蛋白[(38.45±4.22)g/L]、前白蛋白[(204.33±35.62)mg/L]高于TPN组[(20.88±3.31)kg/m~2、(118.37±37.43)g/L、(34.89±5.47)g/L、(193.58±34.96)mg/L],EN组APACHEⅡ[(5.6±2.1)分]和Ranson评分[(1.3±0.7)分]低于TPN组[(7.7±2.3)、(2.9±1.1)分](P<0.05),且2组APACHEⅡ和Ranson评分均低于治疗前(P<0.05);随访6个月,EN组并发症发生率(12.0%)低于TPN组(54.5%)(P<0.05)。结论 EN支持治疗可有效改善老年重症急性胰腺炎患者身体状况,提高患者免疫力,降低并发症发生率,应早期开展。
Objective To investigate the method and effect of the early nutritional support treatment on severe acute pancreatitis in the elderly. Methods Fifty-eight patients aged 60 or older with severe acute pancreatitis were divided into 25 patients receiving enteral nutrition(EN)(EN group) and 33 patients receiving total parenteral nutrition(TPN)(TPN group). The body mass index(BMI), hemoglobin, serum albumin and prealbumin were compared before and after 1-month treatment between two groups. The nutritional status was assessed by APACHEⅡ and Ranson score. The incidences of complications were compared between two groups after 6-months follow-up. Results There were no significant differences in BMI, hemoglobin, albumin, prealbumin, APACHEⅡ and Ranson score between two groups before treatment(P>0.05). After 1-month treatment, BMI((21.13±3.12) kg/m~2), hemoglobin((135.42±29.52) g/L), albumin((38.45±4.22) g/L) and proalbumin((204.33±35.62) mg/L) in EN group were significantly higher than those in TPN group((20.88±3.31) kg/m~2,(118.37±37.43) g/L,(34.89±5.47) g/L,(193.58±34.96) mg/L)(P<0.05), APACHEⅡ(5.6±2.1) and Ranson score(1.3±0.7) in ET group were significantly lower than those in TPN group(7.7±2.3, 2.9±1.1)(P<0.05), and APACHE Ⅱ and Ranson score were significantly lower than those before treatment in both two groups(P<0.05). After 6-month follow-up, the incidence of complications was significantly lower in EN group(12.0%) than that in TPN group(54.5%)(P<0.05). Conclusion EN can effectively improve the health condition in elderly patients,strengthen the immune defense and reduce the incidence of complications,therefore it should be performed as early as possibly.
Objective To investigate the method and effect of the early nutritional support treatment on severe acute pancreatitis in the elderly. Methods Fifty-eight patients aged 60 or older with severe acute pancreatitis were divided into 25 patients receiving enteral nutrition(EN)(EN group) and 33 patients receiving total parenteral nutrition(TPN)(TPN group). The body mass index(BMI), hemoglobin, serum albumin and prealbumin were compared before and after 1-month treatment between two groups. The nutritional status was assessed by APACHEⅡ and Ranson score. The incidences of complications were compared between two groups after 6-months follow-up. Results There were no significant differences in BMI, hemoglobin, albumin, prealbumin, APACHEⅡ and Ranson score between two groups before treatment(P>0.05). After 1-month treatment, BMI((21.13±3.12) kg/m~2), hemoglobin((135.42±29.52) g/L), albumin((38.45±4.22) g/L) and proalbumin((204.33±35.62) mg/L) in EN group were significantly higher than those in TPN group((20.88±3.31) kg/m~2,(118.37±37.43) g/L,(34.89±5.47) g/L,(193.58±34.96) mg/L)(P<0.05), APACHEⅡ(5.6±2.1) and Ranson score(1.3±0.7) in ET group were significantly lower than those in TPN group(7.7±2.3, 2.9±1.1)(P<0.05), and APACHE Ⅱ and Ranson score were significantly lower than those before treatment in both two groups(P<0.05). After 6-month follow-up, the incidence of complications was significantly lower in EN group(12.0%) than that in TPN group(54.5%)(P<0.05). Conclusion EN can effectively improve the health condition in elderly patients,strengthen the immune defense and reduce the incidence of complications,therefore it should be performed as early as possibly.
引文
[1] 范家乔,陈海龙.腹腔巨噬细胞在大鼠重症急性胰腺炎发病机制中作用[J].中华实用诊断与治疗杂志,2014,28(5):460-463.
[2] PORTELLI M, JONES C D. Severe acute pancreatitis: pathogenesis, diagnosis and surgical management[J]. Hepatobiliary Pancreat Dis Int,2017,16(2):155-159.
[3] GARDNER T B, VEGE S S, CHARI S T, et al. The effect of age on hospital outcomes in severe acute pancreatitis[J]. Pancreatol,2008,8(3):265-270.
[4] 朱宗文,李广洲,孙备,等.老年重症急性胰腺炎早期多指标联合预测模型的建立[J].中华外科杂志,2018,56(8):597-602.
[5] 范家乔.腹腔巨噬细胞在重症急性胰腺炎大鼠肠屏障功能损害中作用[J].中华实用诊断与治疗杂志,2014,28(6):556-558.
[6] 谭黄业,樊献军,张力峰,等.重症急性胰腺炎致全身炎症反应综合征诊治分析[J].中华实用诊断与治疗杂志,2009,23(6):610-611.
[7] 田志强,吴涛,陆春雷,等.胃癌术后早期肠内营养与肠外营养的对照研究[J].中华实用诊断与治疗杂志,2012,26(10):1028-1029.
[8] LI W, LIU J, ZHAO S, et al. Safety and efficacy of total parenteral nutrition versus total enteral nutrition for patients with severe acute pancreatitis: a meta-analysis[J]. J Int Med Res,2018,46(9):3948-3958.
[9] 贾鹏冲,薛飞,付强,等.早期肠内营养治疗高脂血症性急性重症胰腺炎的安全性及疗效观察[J].中华实用诊断与治疗杂志,2018,32(10):1022-1024.
[10] JIN Y, XU H, CHEN Y, et al. Therapeutic effect of bifidobacterium combined with early enteral nutrition in the treatment of severe acute pancreatitis: a pilot study[J]. Eur Rev Med Pharmacol Sci,2018,22(12):4018-4024.
[11] PENG L, WU L G, LI B, et al. Early enteral nutrition improves intestinal immune barrier in a rat model of severe acute pancreatitis[J]. J Hepatobiliary Pancreat Sci,2016,23(11):681-687.
[12] ROSENDAHL J. Early or late enteral nutrition in severe acute pancreatitis?[J]. Z Gastroenterol,2015,53(3):244-245.
[13] SHEN Q X, XU G X, SHEN M H. Effect of early enteral nutrition (EN) on endotoxin in serum and intestinal permeability in patients with severe acute pancreatitis[J]. Eur Rev Med Pharmacol Sci,2017,21(11):2764-2768.
[14] 徐冬,荀江.重症急性胰腺炎并持续性炎症-免疫抑制-分解代谢综合征研究进展[J].中华实用诊断与治疗杂志,2018,32(7):725-728.
[15] 刘卫军.生长抑素联合早期肠内营养治疗重症急性胰腺炎32例临床观察[J].中华实用诊断与治疗杂志,2011,25(4):388-389.
[16] 王海波,李敏,邵换璋,等.早期免疫肠内营养对重症胰腺炎患者肠屏障、营养状态及免疫功能的影响[J].医药论坛杂志,2014,35(12):15-18.
[2] PORTELLI M, JONES C D. Severe acute pancreatitis: pathogenesis, diagnosis and surgical management[J]. Hepatobiliary Pancreat Dis Int,2017,16(2):155-159.
[3] GARDNER T B, VEGE S S, CHARI S T, et al. The effect of age on hospital outcomes in severe acute pancreatitis[J]. Pancreatol,2008,8(3):265-270.
[4] 朱宗文,李广洲,孙备,等.老年重症急性胰腺炎早期多指标联合预测模型的建立[J].中华外科杂志,2018,56(8):597-602.
[5] 范家乔.腹腔巨噬细胞在重症急性胰腺炎大鼠肠屏障功能损害中作用[J].中华实用诊断与治疗杂志,2014,28(6):556-558.
[6] 谭黄业,樊献军,张力峰,等.重症急性胰腺炎致全身炎症反应综合征诊治分析[J].中华实用诊断与治疗杂志,2009,23(6):610-611.
[7] 田志强,吴涛,陆春雷,等.胃癌术后早期肠内营养与肠外营养的对照研究[J].中华实用诊断与治疗杂志,2012,26(10):1028-1029.
[8] LI W, LIU J, ZHAO S, et al. Safety and efficacy of total parenteral nutrition versus total enteral nutrition for patients with severe acute pancreatitis: a meta-analysis[J]. J Int Med Res,2018,46(9):3948-3958.
[9] 贾鹏冲,薛飞,付强,等.早期肠内营养治疗高脂血症性急性重症胰腺炎的安全性及疗效观察[J].中华实用诊断与治疗杂志,2018,32(10):1022-1024.
[10] JIN Y, XU H, CHEN Y, et al. Therapeutic effect of bifidobacterium combined with early enteral nutrition in the treatment of severe acute pancreatitis: a pilot study[J]. Eur Rev Med Pharmacol Sci,2018,22(12):4018-4024.
[11] PENG L, WU L G, LI B, et al. Early enteral nutrition improves intestinal immune barrier in a rat model of severe acute pancreatitis[J]. J Hepatobiliary Pancreat Sci,2016,23(11):681-687.
[12] ROSENDAHL J. Early or late enteral nutrition in severe acute pancreatitis?[J]. Z Gastroenterol,2015,53(3):244-245.
[13] SHEN Q X, XU G X, SHEN M H. Effect of early enteral nutrition (EN) on endotoxin in serum and intestinal permeability in patients with severe acute pancreatitis[J]. Eur Rev Med Pharmacol Sci,2017,21(11):2764-2768.
[14] 徐冬,荀江.重症急性胰腺炎并持续性炎症-免疫抑制-分解代谢综合征研究进展[J].中华实用诊断与治疗杂志,2018,32(7):725-728.
[15] 刘卫军.生长抑素联合早期肠内营养治疗重症急性胰腺炎32例临床观察[J].中华实用诊断与治疗杂志,2011,25(4):388-389.
[16] 王海波,李敏,邵换璋,等.早期免疫肠内营养对重症胰腺炎患者肠屏障、营养状态及免疫功能的影响[J].医药论坛杂志,2014,35(12):15-18.