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目的探讨肠内营养在ICU重症胰腺炎患者中的应用效果。方法选取广西民族医院ICU 2014—2016年收治的重症胰腺炎患者80例,采用双色球法随机分为对照组(n=40)和观察组(n=40)。对照组患者给予肠外营养治疗,观察组患者给予肠内营养治疗。比较两组患者治疗前后清蛋白、血红蛋白、C反应蛋白、肿瘤坏死因子及白介素1β,并记录比较两组患者机械通气时间、肠功能恢复时间及住院时间,统计患者不良发生情况及预后(胰腺脓肿、胰腺坏死、胰腺假囊肿、肾衰竭、呼吸衰竭及死亡发生情况)。结果治疗前,两组患者清蛋白、血红蛋白、C反应蛋白、肿瘤坏死因子及白介素1β水平比较,差异无统计学意义(P>0.05);治疗后,观察组患者清蛋白水平高于对照组,血红蛋白、C反应蛋白、肿瘤坏死因子及白介素1β水平低于对照组(P<0.05)。观察组患者机械通气时间、肠功能恢复时间及住院时间短于对照组(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。观察组患者胰腺脓肿、胰腺坏死及胰腺假囊肿发生率低于对照组(P<0.05),但两组患者肾衰竭、呼吸衰竭发生率及病死率比较,差异无统计学意义(P>0.05)。结论肠内营养在ICU重症胰腺炎患者中的应用效果确切,可有效促进患者肠功能恢复,缩短住院时间,减轻机体免疫炎性反应,有助于改善预后。
Objective To investigate the effect of enteral nutrition in patients with severe acute pancreatitis in ICU. Methods Eighty patients with severe pancreatitis admitted to ICU of Guangxi Ethnic Minority Hospital from 2014 to 2016 were randomly divided into control group (n = 40) and observation group (n = 40) by double color ball method. Control group patients were given parenteral nutrition treatment, observation group patients given enteral nutrition treatment. Preoperative and postoperative albumin, hemoglobin, C-reactive protein, tumor necrosis factor and interleukin-1β were compared between the two groups. The mechanical ventilation time, recovery time of intestinal function and hospital stay were recorded and compared between the two groups. The incidence and prognosis of patients with pancreatic abscess , Pancreatic necrosis, pseudocyst of pancreas, renal failure, respiratory failure, and death). Results Before treatment, the levels of albumin, hemoglobin, C-reactive protein, tumor necrosis factor and interleukin-1β were not significantly different between the two groups (P> 0.05). After treatment, the albumin level in observation group was higher than that in control group, Hemoglobin, C-reactive protein, tumor necrosis factor and interleukin-1β levels were lower than those in the control group (P <0.05). The observation group patients with mechanical ventilation time, intestinal function recovery time and hospital stay shorter than the control group (P <0.05). Two groups of patients with adverse reactions, the difference was not statistically significant (P> 0.05). The incidence of pancreatic abscess, pancreatic necrosis and pancreatic pseudocyst in the observation group was lower than that of the control group (P <0.05), but there was no significant difference between the two groups in the incidence of renal failure, respiratory failure and mortality (P> 0.05) . Conclusion Enteral nutrition is effective in patients with severe acute pancreatitis in ICU, which can effectively promote the recovery of intestinal function, shorten the length of hospital stay, reduce the immune-inflammatory reaction and improve the prognosis.