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目的:分析重症胰腺炎患者营养支持的治疗效果。方法:将我院84例重症胰腺炎患者随机分为两组,即治疗组与对照组。治疗组患者在不同阶段给予肠外营养支持与肠内营养支持治疗;而对照组患者通过中心静脉注入的方式给予全肠外营养支持治疗。对两组患者的营养状况、急性阶段反应、肠黏膜穿孔、胰腺损害、免疫功能等各项指标进行检测。结果:治疗组与对照组相比,患者的体质量与前白蛋白指标数值增加(P<0.5),检测白蛋白的数值没有明显的上升。治疗组在治疗7天后急性生理与慢性健康状态(APACHEⅡ)评分下降,而对照组在治疗第11天开始下降。治疗组在治疗4天后白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)及血清C反应蛋白的浓度开始下降,而对照组在治疗第7天开始下降。两组患者均未发现胰腺损伤。治疗组患者在内毒素浓度与尿乳果糖(L):甘露醇(M)的比值无改变,而对照组患者的这两个指标显著升高。对照组与治疗组相比,CD4/CD8与Ig G浓度下降明显(P<0.5)。结论:肠外营养支持与肠内营养支持的混合治疗与全肠外营养支持的治疗相比,前者能改善患者营养状况,可以有效缓解急性期反应,同时前者早保护肠黏膜的完整性及免疫功能方面都具有优势。对患者进行肠内营养支持治疗并不会刺激胰腺使其分泌胰液扩大胰腺炎症范围。对重症胰腺炎患者实施肠外营养支持与肠内营养支持的混合治疗的效果是比较好的。
Objective: To analyze the therapeutic effect of nutritional support in patients with severe acute pancreatitis. Methods: 84 cases of severe pancreatitis in our hospital were randomly divided into two groups, the treatment group and the control group. Patients in the treatment group were given parenteral nutrition support and enteral nutrition support in different stages, while patients in the control group were given parenteral nutrition support by central venous injection. The nutritional status, acute phase response, intestinal mucosal perforation, pancreatic damage, immune function and other indicators were detected in two groups of patients. Results: Compared with the control group, the body weight and prealbumin index of the treatment group increased (P <0.5), and the value of albumin detection did not increase significantly. The APACHE II score decreased in the treatment group 7 days after treatment, while the control group began to decline on the 11th day. After treatment for 4 days, the concentrations of IL-6, TNF-α and serum C-reactive protein in the treatment group began to decrease, while the control group began to decline on the 7th day. No pancreatic injury was found in either group. In the treatment group there was no change in the ratio of endotoxin to lacto-lactalbumin (L): mannitol (M), whereas both patients in the control group were significantly elevated. Compared with the treatment group, CD4 / CD8 and Ig G concentrations decreased significantly (P <0.5). CONCLUSIONS: Compared with total parenteral nutrition treatment, the former can improve nutritional status of patients and can effectively relieve the acute phase reaction, while the former can protect the integrity and immunity of intestinal mucosa as early as possible Function has advantages. Enteral nutrition for patients with supportive treatment does not stimulate the pancreas to secrete pancreatic juice to expand the scope of pancreatic inflammation. The effect of parenteral nutrition and enteral nutrition support on patients with severe pancreatitis is better.