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目的:比较早期肠内生态免疫营养(EIN)与常规早期肠内营养(EN)支持对重症急性胰腺炎(SAP)患者的临床效果。方法:将64例先后入院的SAP患者随机分为观察组和对照组,每组32例,两组早期给予EN;观察组在此基础上应用谷氨酰胺颗粒及三联活菌制剂。观察两组的病例脱落情况,以及EN支持前与EN支持9 d后的营养状况、炎性指标及全血细菌DNA阳性率、血浆D-乳酸、血浆二胺氧化酶(DAO)、血浆内毒素及尿中乳果糖/甘露醇(L/M)比值。结果:对照组有4例患者脱落未能按照营养支持要求进行。与EN前比较,EN支持9 d后,两组血清白蛋白、前白蛋白、转铁蛋白变化绝对值均升高;白细胞介素2、白细胞介素6、肿瘤坏死因子α均降低;全血细菌DNA阳性率、血浆D-乳酸、血浆DAO、血浆内毒素和尿L/M比值均降低,但观察组以上各项指标的变化幅度均明显大于对照组(均P<0.05)。结论:早期合理的EIN有利于改善SAP患者营养状况、抑制炎症反应、维护肠黏膜屏障功能,值得临床应用。
Objective: To compare the clinical effects of early enteral immunization (EIN) and conventional early enteral nutrition (EN) support in patients with severe acute pancreatitis (SAP). Methods: Sixty-four SAP patients admitted to hospital were randomly divided into observation group and control group, 32 cases in each group. Both groups were given EN at an early stage. On the basis of this observation group, glutamine granules and triple viable preparations were used. The incidence of exfoliation and the nutritional status, inflammatory index and the positive rate of whole blood bacterial DNA, plasma D-lactate, plasma diamine oxidase (DAO), plasma endotoxin And urinary lactulose / mannitol (L / M) ratio. RESULTS: Four patients in the control group were not able to fall off as required by nutritional support. Compared with the pre EN, the absolute value of serum albumin, prealbumin and transferrin in both groups increased after 9 days of EN support; the levels of interleukin 2, interleukin 6 and tumor necrosis factor α decreased; Bacterial DNA positive rate, plasma D-lactate, plasma DAO, plasma endotoxin and urinary L / M ratio were decreased, but the changes in the above indicators of the observation group were significantly greater than the control group (P <0.05). Conclusion: Early rational EIN is beneficial to improve the nutritional status of patients with SAP, inhibit the inflammatory response and maintain the barrier function of intestinal mucosa, which is worthy of clinical application.