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目的探讨经皮内镜空肠造瘘(PEG/J)术置管行早期肠内营养(EN)对重症急性胰腺炎(SAP)的治疗效果。方法回顾性分析了90例SAP患者的治疗情况,其中45例行PEG/J术置管早期肠内营养治疗(PEG/J组),45例行常规治疗(对照组)。90例患者于入院后1、12和18 d分别采集空腹外周静脉血,用酶联免疫吸附法测定白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α);三肽偶氮显色法测定内毒素含量,异硫氰酸荧光素(FITC)标记间接免疫荧光染色法测定CD4/CD8。结果入院后12和18 d PEG/J组患者血浆中IL-6、TNF-α及内毒素含量显著低于对照组(P<0.01),而CD4/CD8比值高于对照组(P<0.01),入院1 d PEG/J组IL-6、TNF-α、内毒素及CD4/CD8比值与对照组比较差异均无统计学意义(P>0.05)。对照组平均13.5 d体温恢复正常;并发上消化道出血2例,假性囊肿形成4例,二重感染2例;平均住院时间为33.5 d。PEG/J组平均10.5 d体温恢复正常;无并发上消化道出血及二重感染的病例,并发假性囊肿形成2例;平均住院时间为28 d。结论 PEG/J术置管行早期EN治疗SAP,疗效满意。
Objective To investigate the effect of early enteral nutrition (EN) on the treatment of severe acute pancreatitis (SAP) by percutaneous endoscopic jejunostomy (PEG / J). Methods The clinical data of 90 patients with SAP were retrospectively analyzed. Among them, 45 patients underwent PEG / J catheterization of early enteral nutrition (PEG / J group) and 45 patients received conventional therapy (control group). Fasting peripheral venous blood was collected from 90 patients at 1, 12 and 18 days after admission, and the levels of IL-6 and TNF-α were determined by enzyme-linked immunosorbent assay. The contents of endotoxin were determined by azo coloration method and indirect immunofluorescence staining with fluorescein isothiocyanate (FITC) was used to detect the ratio of CD4 / CD8. Results The plasma levels of IL-6, TNF-α and endotoxin in PEG / J group were significantly lower than those in control group (P <0.01) and CD4 / CD8 ratio at 12 and 18 days after admission There was no significant difference in the ratio of IL-6, TNF-α, endotoxin and CD4 / CD8 in the PEG / J group on the 1st day of admission compared with the control group (P> 0.05). In the control group, the body temperature returned to normal on the average of 13.5 days. There were 2 cases of upper gastrointestinal bleeding, 4 cases of pseudocyst and 2 cases of double infection. The average length of stay was 33.5 days. In the PEG / J group, the body temperature returned to normal on the average of 10.5 days. In the cases without concurrent upper gastrointestinal bleeding and double infection, two cases were complicated with pseudocyst. The average hospitalization time was 28 days. Conclusion PEG / J operation tube early EN treatment of SAP, with satisfactory results.