本文選題：重癥急性胰腺炎 + 生態(tài)免疫營(yíng)養(yǎng)　； 參考：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:探討重癥急性胰腺炎(SAP)經(jīng)介入引流后,早期腸內(nèi)生態(tài)免疫營(yíng)養(yǎng)對(duì)患者營(yíng)養(yǎng)狀態(tài)、免疫功能、炎癥反應(yīng)和預(yù)后方面的臨床療效。方法:選擇2012年01月-2014年12月我院收治的35例SAP患者作為研究對(duì)象,均符合SAP診斷標(biāo)準(zhǔn)。將35例患者隨機(jī)分為2組:靜脈營(yíng)養(yǎng)組(PN組,15例)和腸內(nèi)生態(tài)免疫營(yíng)養(yǎng)組(EEIN組,20例)。PN組接受3L袋的全胃腸外營(yíng)養(yǎng);EEIN組的胰腺壞死組織經(jīng)超聲介入穿刺引流內(nèi)24h,通過內(nèi)鏡引導(dǎo)放置鼻腸營(yíng)養(yǎng)管行生態(tài)免疫營(yíng)養(yǎng)。2組患者均于治療前及治療后7d和14d分別取血測(cè)定前白蛋白(PAB)、轉(zhuǎn)鐵蛋白(TF);C反應(yīng)蛋白(CRP)、腫瘤壞死因子-α(TNF-α)、白介素-6(IL-6);CD4+、CD8+、CD4+/CD8+的T淋巴細(xì)胞亞群;Ig A、Ig G、Ig M免疫球蛋白各項(xiàng)指標(biāo)。并觀察2組患者的腹部癥狀,統(tǒng)計(jì)2組患者感染率、大便菌群失調(diào)和中轉(zhuǎn)手術(shù)率。結(jié)果:1治療后2組患者的前白蛋白、轉(zhuǎn)鐵蛋白均有不同程度升高,EEIN組高于PN組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);2營(yíng)養(yǎng)治療后,2組患者CD4+、CD8+、CD4+/CD8+的T淋巴細(xì)胞亞群及免疫球蛋白Ig A逐漸升高,EEIN組高于PN組,差異有統(tǒng)計(jì)學(xué)意義(P0.05),但I(xiàn)g G、Ig M差異無統(tǒng)計(jì)學(xué)意義(P0.05);3營(yíng)養(yǎng)治療后,2組患者CRP、IL-6、TNF-α逐漸降低;EEIN組低于PN組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);4在改善患者的腹部癥狀,并發(fā)感染率、大便菌群失調(diào)和中轉(zhuǎn)手術(shù)率方面,EEIN組優(yōu)于PN組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:穿刺引流術(shù)能減輕SAP患者的腹部癥狀,早期腸內(nèi)生態(tài)免疫營(yíng)養(yǎng)可以改善SAP患者營(yíng)養(yǎng)代謝和免疫功能,促進(jìn)消化道功能的恢復(fù),防止細(xì)菌移位,減輕炎性反應(yīng),其作用優(yōu)于靜脈營(yíng)養(yǎng)。
[Abstract]:Objective: to investigate the effect of early enteral ecological immune nutrition on nutritional status, immune function, inflammatory reaction and prognosis of patients with severe acute pancreatitis (SAP) after interventional drainage. Methods: 35 patients with SAP admitted in our hospital from January 2012 to December 2014 were selected as study subjects, all of whom were in accordance with the diagnostic criteria of SAP. 35 patients were randomly divided into two groups: intravenous nutrition group (PN group, n = 15) and enteral ecological immune nutrition group (EPI group, n = 20). The pancreatic necrotic tissue of the EEIN group received 3L bag of total parenteral nutrition for 24 hours. Eco-immune nutrition with naso-enteral nutrition tube guided by endoscope. 2 patients in group 2 were treated with EIAN before treatment, 7 days and 14 days after treatment, respectively. The blood samples were taken to determine the levels of prealbumin, transferrin, TFTF-C-reactive protein, tumor necrosis factor- 偽 TNF- 偽, interleukin-6IL-6CD4, CD8 / CD8 and CD4 / CD8 / CD8 respectively. The T lymphocyte subsets of Ig G G G M immunoglobulin. The abdominal symptoms of the two groups were observed, and the infection rate, stool flora imbalance and the rate of conversion to surgery were counted. Results the levels of prealbumin and transferrin in both groups were higher than those in PN group. There was a significant difference in the T lymphocyte subsets and immunoglobulin IgA in CD4 CD8 / CD 4 / CD 8 between the two groups after nutritional therapy. The level of immunoglobulin IgA in EEIN group was higher than that in PN group. The difference was statistically significant (P 0.05), but there was no significant difference between the two groups (P 0.05). After nutrition treatment, the level of CRPIL-6 / TNF- 偽 in the two groups was lower than that in the PN group. The difference was statistically significant (P 0.05) in improving abdominal symptoms and complicated with infection rate. The fecal dysbacteriosis and the rate of conversion to surgery in EEIN group were better than those in PN group, and the difference was statistically significant (P 0.05). Conclusion: puncture and drainage can relieve abdominal symptoms of SAP patients. Early enteral ecological immune nutrition can improve nutritional metabolism and immune function of SAP patients, promote the recovery of digestive tract function, prevent bacterial translocation and alleviate inflammatory reaction. Its effect is superior to intravenous nutrition.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R657.51

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