本文選題：重癥胰腺炎 + 腸內(nèi)營養(yǎng)��； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：重癥急性胰腺炎約占急性胰腺炎的5%--10%,病情兇險,死亡率高達30%--50%。治療方式主要為禁食、補液、臟器功能支持、抑制胰腺分泌、營養(yǎng)支持、并發(fā)癥治療等。其中,營養(yǎng)支持成為治療重癥胰腺炎的一個重要環(huán)節(jié)。營養(yǎng)方式分為腸內(nèi)營養(yǎng)與腸外營養(yǎng)。在過去,首先推薦腸外營養(yǎng),認為可使胰腺處于"休息"狀態(tài),減少胰腺外分泌,減輕胰腺自身消化程度。近年來,腸內(nèi)營養(yǎng)地位逐年上升,研究認為可以減少感染率。相關(guān)指南首先推薦腸內(nèi)營養(yǎng),一般在入院3-5天內(nèi)需開始,最晚不超過1周。若對腸內(nèi)營養(yǎng)不能耐受或有禁忌癥,可考慮腸外營養(yǎng)代替。關(guān)于更早進行腸內(nèi)營養(yǎng)(48小時內(nèi))能否獲得更大收益,目前仍有爭議。方法:選擇2013年1月1日至2016年9月30日入住邵逸夫醫(yī)院重癥急性胰腺炎患者48人,按照入院后腸內(nèi)營養(yǎng)(通過鼻空腸管輸注百普力營養(yǎng)液)開始時間,分為超早期營養(yǎng)組(入院48小時內(nèi)開始)和普通早期組(入院48小時至7天內(nèi)開始),通過比較兩組患者的住院時間、6個月內(nèi)并發(fā)癥(臟器功能衰竭、假性囊腫、消化道瘺、胰周血管并發(fā)癥)、28天死亡率、6個月死亡率、感染相關(guān)指標、白蛋白水平情況,探討超早期腸內(nèi)營養(yǎng)(48小時內(nèi))對重癥急性胰腺炎預(yù)后的影響。結(jié)果:治療前,兩組患者男女比例分別為10/7和14/17,年齡分別為49.53±14.69歲和53.94±9.68歲,APCHE Ⅱ評分分別為14.47±6.26分和14.26±5.18分,病因中膽源性比例分別為59%和68%,高脂血癥性比例分別為29%和13%,其他原因(酒精性、ERCP術(shù)后引起)比例分別為12%和19%,各組間比較P值均大于0.05;治療后,兩組平均住院時間分別為24.12±14.38天和27.71±25.34天(P0.05),其中腎功能衰竭人數(shù)分別為3人(18%)和3人(10%)(P0.05),呼吸衰竭人數(shù)分別為8人(47%)和18人(58%)(P0.05),出現(xiàn)假性囊腫人數(shù)分別為8人(47%)和13人(42%X P0.05),出現(xiàn)消化道瘺人數(shù)分別為0人(0%)和2人(6%X P0.05),出現(xiàn)胰周血管并發(fā)癥人數(shù)分別為2人(12%)和2人(6%)(P0.05),28天死亡率分別為12%和3%(P0.05),6個月死亡率分別為18%和6%(P0.05),差異無統(tǒng)計學(xué)意義。24小時內(nèi)CRP水平分別為161.13±126.82mg/L和116.28±102.94mg/L(P0.05),CRP 最高值水平分別為 295.68±69.53mg/L 和 248.26±75.31mg/L(P0.05),2 周時 CRP 分別為 78.00±90.70mg/L 和 61.25±63.16mg/L(P0.05),出現(xiàn)肺部感染6%和10%(P0.05),菌血癥分別為12%和13%(P0.05),胰腺壞死分別為0%和19%(P0.05),入院后24小時內(nèi)白蛋白水平分別為35.31±6.36g/L和 35.67±7.22g/L(P0.05),2 周時白蛋白水平分別為 33.00±6.08g/L 和 34.19±4.46g/L(P0.05),ΔALB 分別為 2.30±8.14g/L 和 1.47±8.55g/L(P0.05),開放飲食時間分別為 16.58±5.07 天和 14.22±8.27 天(P0.05)。結(jié)論:根據(jù)本回顧性分析結(jié)果,對重癥急性胰腺炎患者,相對于普通早期腸內(nèi)營養(yǎng)(入院48小時后至7天),超早期腸內(nèi)營養(yǎng)(入院48小時內(nèi))對急性重癥胰腺炎的預(yù)后并無明顯的影響。
[Abstract]:Severe acute pancreatitis accounts for about 5-10 percent of acute pancreatitis, the disease is dangerous, the death rate is as high as 30-50. The main treatment methods were fasting, fluid rehydration, organ function support, pancreatic secretion inhibition, nutritional support, complications treatment and so on. Among them, nutritional support has become an important link in the treatment of severe pancreatitis. Nutrition is divided into enteral nutrition and parenteral nutrition. In the past, parenteral nutrition was first recommended as a way to "rest" the pancreas, reduce exocrine secretion and reduce the degree of pancreatic autodigestion. In recent years, the status of enteral nutrition has increased year by year. The guidelines first recommend enteral nutrition, usually starting with 3-5 days of hospitalization and no later than 1 week. If enteral nutrition is intolerable or contraindicated, parenteral nutrition may be considered instead. There is still debate about the benefits of early enteral nutrition (within 48 hours). Methods: from January 1, 2013 to September 30, 2016, 48 patients with severe acute pancreatitis admitted to run Shaw Hospital were enrolled in the study. The patients were divided into two groups: the ultra-early nutrition group (starting within 48 hours of admission) and the general early group (starting within 48 hours to 7 days of admission). By comparing the length of stay, the complications within 6 months (organ failure, pseudocyst, gastrointestinal fistula) were compared between the two groups. The mortality rate of 28 days, 6 months mortality, infection related index, albumin level, and the effect of super early enteral nutrition (within 48 hours) on the prognosis of severe acute pancreatitis were investigated. Results: before treatment, the ratio of male to female was 10 / 7 and 14 / 17, and the age was 49.53 鹵14.69 years old and 53.94 鹵9.68 years old respectively. The scores of APCHE 鈪，

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