本文關(guān)鍵詞： 腸道營(yíng)養(yǎng) 重癥急性胰腺炎 腹內(nèi)高壓 免疫活性　出處：《中國(guó)全科醫(yī)學(xué)》2016年14期 　論文類型：期刊論文

【摘要】：目的比較早期腸內(nèi)營(yíng)養(yǎng)與延遲腸內(nèi)營(yíng)養(yǎng)對(duì)重癥急性胰腺炎(SAP)患者腹內(nèi)高壓及免疫功能的影響。方法選取2013年1月—2014年12月在皖南醫(yī)學(xué)院附屬弋磯山醫(yī)院急診內(nèi)科就診的SAP患者40例,按照隨機(jī)數(shù)字表法將其分為觀察組和對(duì)照組,各20例。在綜合治療的基礎(chǔ)上,觀察組患者入院48 h后行腸內(nèi)營(yíng)養(yǎng)支持治療,對(duì)照組患者在入院后5 d予腸內(nèi)營(yíng)養(yǎng)支持。兩組腸內(nèi)營(yíng)養(yǎng)支持干預(yù)療程均為2周。分別記錄兩組治療前后腹內(nèi)壓(IAP)及腹內(nèi)高壓發(fā)生率;檢測(cè)兩組治療前后血清免疫球蛋白(IgG、IgM、IgA)及外周血T淋巴細(xì)胞亞群(CD_3~+、CD_4~+、CD_4~+/CD_8~+)水平;記錄兩組治療前后血淀粉酶、體質(zhì)指數(shù)(BMI)及視覺(jué)模擬評(píng)分(VAS)。結(jié)果兩組患者治療前IAP比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);治療后,觀察組IAP低于對(duì)照組(P0.05);且兩組患者IAP均低于同組治療前(P0.05)。兩組患者第1天和第14天腹內(nèi)高壓發(fā)生率比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);觀察組第7天和第10天腹內(nèi)高壓發(fā)生率低于對(duì)照組(P0.05)。治療前,兩組患者血清免疫球蛋白IgG、IgM、IgA及外周血T淋巴細(xì)胞亞群CD_3~+、CD_4~+、CD_4~+/CD_8~+水平比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);治療后,觀察組血清免疫球蛋白IgG、IgM、IgA及外周血T淋巴細(xì)胞亞群CD_3~+、CD_4~+、CD_4~+/CD_8~+水平均高于對(duì)照組(P0.05);兩組治療后血清免疫球蛋白IgG、IgM、IgA及外周血T淋巴細(xì)胞亞群CD_3~+、CD_4~+、CD_4~+/CD_8~+水平均高于同組治療前(P0.05)。治療前,兩組血淀粉酶、BMI及VAS比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);治療后,觀察組血淀粉酶、BMI及VAS均低于對(duì)照組(P0.05);兩組治療后血淀粉酶、BMI及VAS均較治療前降低(P0.05)。治療過(guò)程中對(duì)照組患者有5例發(fā)生不良反應(yīng),觀察組有3例發(fā)生不良反應(yīng),兩組不良反應(yīng)發(fā)生率比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(χ~2=0.625,P0.05)。結(jié)論早期腸內(nèi)營(yíng)養(yǎng)可以明顯降低SAP患者腹內(nèi)高壓發(fā)生率,調(diào)節(jié)并改善機(jī)體的免疫功能,從而改善患者的預(yù)后情況。
[Abstract]:Objective to compare the effects of early enteral nutrition and delayed enteral nutrition on abdominal hypertension and immune function in patients with severe acute pancreatitis (SAP). 40 SAP patients, According to the method of random number table, the patients in the observation group were divided into two groups, 20 cases in each group. On the basis of comprehensive treatment, the patients in the observation group received enteral nutrition support therapy 48 hours after admission. The patients in the control group were given enteral nutrition support 5 days after admission. The course of intervention was 2 weeks. The incidence of intraabdominal pressure (IAPs) and intraabdominal hypertension were recorded before and after treatment in both groups. Before and after treatment, the levels of serum immunoglobulin (IgG) and peripheral blood T lymphocyte subsets (CD3 ~ + CD4 ~ / CD8 ~), serum amylase, body mass index (BMI) and visual analogue score (VASA) were measured before and after treatment in both groups. Results IAP was compared between the two groups before and after treatment. After treatment, the IAP of the observation group was lower than that of the control group (P 0.05), and the IAP of the two groups was lower than that of the same group before treatment (P 0.05). The incidence of intraabdominal hypertension in the two groups on the 1st and 14th day was higher than that in the control group. The incidence of intraabdominal hypertension in the observation group was lower than that in the control group on the 7th and 10th day. Before treatment, the levels of serum immunoglobulin IgG titer IgMU IgA and peripheral blood T lymphocyte subgroup CD3 ~ + CD4 ~ + CD4 ~ / CD8 ~ were compared between the two groups. The difference was not statistically significant (P 0.05). The levels of serum immunoglobulin (IgG) IgMU IgMU IgA and peripheral blood T lymphocyte subsets (CD3 ~ CD4 ~ / CD8 ~ +) in the observation group were higher than those in the control group (P0.05), and the levels of serum immunoglobulin (IgG) IgMU IgMMU IgA and peripheral blood T lymphocyte subsets (CD3 ~ CD4 ~ + / CD8 ~) were higher in the observation group than in the control group (P < 0.05), and the levels of CD3 ~ CD4 ~ / CD8 ~ + were higher in the observation group than in the control group (P < 0.05). Before treatment, P0.05. There was no significant difference in serum amylase and VAS between the two groups (P 0.05). The levels of serum amylase and VAS in the observation group were lower than those in the control group (P 0.05), and the levels of serum amylase and VAS in the two groups were lower than those before treatment. During the course of treatment, 5 patients in the control group had adverse reactions, and 3 patients in the observation group had adverse reactions. There was no significant difference in the incidence of adverse reactions between the two groups (蠂 ~ (2 +)) (蠂 ~ (2 +)) 0.625 (P 0.05). Conclusion early enteral nutrition can significantly reduce the incidence of intra-abdominal hypertension in patients with SAP, regulate and improve the immune function of the body, and thus improve the prognosis of the patients.
【作者單位】： 皖南醫(yī)學(xué)院附屬弋磯山醫(yī)院;
【分類號(hào)】：R576

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