本文選題：重癥急性胰腺炎 + 早期鼻空腸營養(yǎng)��； 參考：《山東中醫(yī)藥大學(xué)》2015年碩士論文

【摘要】：目的:探討早期鼻空腸營養(yǎng)給予整蛋白制劑與短肽制劑治療急性重癥胰腺炎的對比分析;探討早期胃腸功能復(fù)蘇聯(lián)合早期腸內(nèi)營養(yǎng)支持治療SAP的臨床價(jià)值。方法:本研究選取千佛山醫(yī)院ICU 50例SAP病例進(jìn)行回顧性分析,分為整蛋白制劑組(治療組)25例,短肽制劑組(對照組)25例。分別檢測患者營養(yǎng)支持治療前與營養(yǎng)支持治療2周后的評(píng)分指標(biāo)、營養(yǎng)指標(biāo)、胃腸功能恢復(fù)指標(biāo)、各項(xiàng)感染指標(biāo)及預(yù)后指標(biāo)等的變化,并對治療組與對照組各項(xiàng)指標(biāo)進(jìn)行對比分析。探討早期鼻導(dǎo)管空腸營養(yǎng)給予整蛋白制劑與短肽制劑對急性重癥胰腺炎患者治療的對比分析,觀察早期腸內(nèi)營養(yǎng)開啟時(shí)間,探討整蛋白制劑與短肽營養(yǎng)制劑對SAP患者預(yù)后有無明顯差異。結(jié)果:在胃腸功能恢復(fù)方面,治療組腹內(nèi)壓測定均明顯小于對照組,P0.05,有統(tǒng)計(jì)學(xué)意義;評(píng)分指標(biāo)方面,經(jīng)獨(dú)立樣本t檢驗(yàn)APACHEII評(píng)分、SOFE評(píng)分P0.05有明顯差異,有統(tǒng)計(jì)學(xué)意義;營養(yǎng)風(fēng)險(xiǎn)評(píng)分、CT嚴(yán)重程度兩項(xiàng)指標(biāo)P0.05無明顯差異;感染指標(biāo)方面,治療組和對照組感染指標(biāo)白細(xì)胞計(jì)數(shù)、PCT、血淀粉酶含量三項(xiàng)指標(biāo)經(jīng)獨(dú)立樣本t檢驗(yàn)P0.05無明顯差別。表明給予重癥急性胰腺炎患者整蛋白制劑及短肽制劑對患者感染指標(biāo)的降低無明顯差別;并發(fā)癥方面,經(jīng)Fisher確切概率法檢驗(yàn),治療組的胃腸道并發(fā)癥明顯少于對照組,P0.05,有統(tǒng)計(jì)學(xué)意義;對照組與治療組代謝并發(fā)癥經(jīng)Fisher確切概率法檢驗(yàn),P0.01,兩組有明顯差異,表明治療組代謝并發(fā)癥明顯少于對照組。但治療組與對照組機(jī)械并發(fā)癥與感染并發(fā)癥經(jīng)檢驗(yàn),P0.05,兩組無明顯差異;營養(yǎng)指標(biāo)方面,治療組與對照組白蛋白、前白蛋白經(jīng)獨(dú)立樣本t檢驗(yàn),P0.05,無統(tǒng)計(jì)學(xué)意義;但治療組急性時(shí)相鐵蛋白明顯低于對照組,P0.01,有顯著差異。結(jié)論:1.SAP患者早期鼻空腸給予整蛋白制劑與短肽營養(yǎng)制劑相比,整蛋白制劑能明顯降低SAP患者胃腸道并發(fā)癥發(fā)生率,特別是腹內(nèi)壓測定方面。兩種制劑均能改善患者臨床癥狀,整蛋白制劑能更快促進(jìn)APACHEII評(píng)分、SOFE評(píng)分指標(biāo)恢復(fù)正常。2.SAP患者早期鼻空腸給予整蛋白制劑與短肽營養(yǎng)制劑相比,兩者在腸內(nèi)營養(yǎng)開啟時(shí)間方面、營養(yǎng)指標(biāo)白蛋白及前白蛋白增高方面無明顯差異,兩者在28天病死率及ICU住院時(shí)間等預(yù)后指標(biāo)方面無明顯差異,兩者在CT評(píng)分及感染指標(biāo)方面無明顯差異。3.整蛋白制劑含有更多的谷氨酰胺,在提高重癥胰腺炎患者免疫力,改善機(jī)體代謝、氮平衡,促進(jìn)蛋白質(zhì)合成,增加淋巴細(xì)胞總數(shù)等方面較短肽營養(yǎng)制劑有優(yōu)勢,利于改善重癥急性胰腺炎患者的預(yù)后。
[Abstract]:Objective: to explore the clinical value of early gastrointestinal resuscitation combined with early enteral nutrition in the treatment of SAP. Methods: 50 cases of SAP in ICU of Qianfushan Hospital were retrospectively analyzed and divided into treatment group (25 cases) and short peptide group (25 cases). The scores, nutritional indexes, gastrointestinal function recovery index, infection index and prognosis index were measured before and 2 weeks after nutritional support treatment, respectively. The indexes of treatment group and control group were compared and analyzed. To investigate the effect of early nasal catheter jejunal nutrition on patients with severe acute pancreatitis (SAP) and to observe the opening time of early enteral nutrition. To investigate the difference of prognosis between whole protein preparation and short peptide nutrition preparation in SAP patients. Results: in the recovery of gastrointestinal function, the intraabdominal pressure in the treatment group was significantly lower than that in the control group (P 0.05), and in the scoring index, there was a significant difference in Apache II score and SOFE score (P0.05) by independent sample t-test. There was no significant difference between the two indexes of nutritional risk score and CT severity (P0.05). In terms of infection index, there was no significant difference between treatment group and control group in leukocyte count (PCT) and serum amylase content (P 0.05) by independent sample t test (P0.05). The results showed that there was no significant difference in the reduction of infection index between the whole protein preparation and the short peptide preparation in the patients with severe acute pancreatitis, and the exact Fisher probability method was used to test the complications. The gastrointestinal complications in the treatment group were significantly lower than those in the control group (P 0.05), and the metabolic complications in the control group and the treatment group were tested by Fisher exact probability test (P 0.01), indicating that the metabolic complications in the treatment group were significantly lower than those in the control group. However, there was no significant difference in the mechanical complications and infection complications between the treatment group and the control group (P 0.05), but there was no significant difference in nutritional indexes between the treatment group and the control group (P 0.05), the albumin and prealbumin in the treatment group and the control group were tested by independent sample t test (P 0.05). But the acute phase ferritin in the treatment group was significantly lower than that in the control group (P 0.01). Conclusion: 1. Early naso-jejunal administration of integral protein preparation in SAP patients can significantly reduce the incidence of gastrointestinal complications, especially in the measurement of intra-abdominal pressure, compared with short peptide nutrition preparation. Both of the two preparations could improve the clinical symptoms of the patients, and the whole protein preparation could accelerate the recovery of Apache II score and SOFE score. 2. Compared with the short peptide nutrition preparation, the whole protein preparation in early naso-jejunal administration of SAP patients had a significant effect on the enteral nutrition opening time. There was no significant difference in nutritional index, albumin and prealbumin, but there was no significant difference in mortality of 28 days and ICU hospitalization time between them. There was no significant difference in CT score and infection index between them. The whole protein preparation contains more glutamine, which has advantages in improving immunity, improving metabolism, nitrogen balance, promoting protein synthesis, increasing the total number of lymphocytes and so on in patients with severe pancreatitis. It is beneficial to improve the prognosis of patients with severe acute pancreatitis.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R576

【相似文獻(xiàn)】

相關(guān)會(huì)議論文 前1條

1 于鳳梅;饒志勇;柳園;潘興昌;蔡木易;羊長青;胡雯;;海洋短肽制劑在惡性腫瘤化療患者中的臨床應(yīng)用觀察[A];第13屆全國臨床營養(yǎng)學(xué)術(shù)會(huì)議資料匯編[C];2011年

相關(guān)碩士學(xué)位論文 前1條

1 劉曉麗;整蛋白與短肽制劑在重癥急性胰腺炎患者營養(yǎng)支持中的應(yīng)用[D];山東中醫(yī)藥大學(xué);2015年

，

本文編號(hào)：1988352