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目的:通过观察不同时间早期肠内营养对急性重症胰腺炎患者的影响,探讨急性重症胰腺炎患者早期肠内营养的最佳时机。方法:将重症急性胰腺炎患者60例分为三组:A组、B组和C组,每组20例。A组为肠外营养组予以常规治疗,B组在常规治疗的基础上通过鼻空肠管在入院3-5天内予以早期肠内营养,C组在常规治疗的基础上通过鼻空肠管在入院5天后予以早期肠内营养。抽取所有患者入院时、入院后3天、7天、14天静脉血,ELISA法测定患者血清中TNF-α、IL-6含量,并记录患者住院期间感染率、病死率、并发症发生率、住院时间、住院费用等。结果:各组患者血清中TNF-α、IL-6含量逐渐下降,B组和C组下降较A组下降明显,差异有统计学意义(P<0.05),B组和C组比较B组予以肠内营养后下降较C组明显,差异有统计学意义(P<0.05)。B组和C组感染率、病死率、并发症发生率、住院时间、住院费用较A组明显低(P<0.05),B组与C组比较感染率、病死率、并发症发生率B组明显低于C组(P<0.05)。结论:早期肠内营养可改善急性重症胰腺炎早期炎症反应,从而减低感染率、病死率、并发症发生率。在患者循环稳定条件下,越早予以肠内营养对患者的预后越有利。
Objective: To observe the effect of early enteral nutrition on patients with severe acute pancreatitis at different time and to explore the best timing of early enteral nutrition in patients with severe acute pancreatitis. Methods: Sixty patients with severe acute pancreatitis were divided into three groups: group A, group B and group C, with 20 cases in each group. A group of parenteral nutrition group to be treated routinely, B group on the basis of conventional treatment through the nasal jejunum within 3-5 days of admission to give early enteral nutrition, C group on the basis of conventional treatment through the nasal jejunum in admission 5 Days after early enteral nutrition. All patients were enrolled in the hospital, 3 days after admission, 7 days, 14 days of venous blood, serum TNF-α and IL-6 levels were measured by ELISA, and the patient’s infection rate during hospitalization, mortality, complication rate, Length of stay, cost of hospitalization, etc. Results: The levels of TNF-α and IL-6 in serum of patients in each group decreased gradually. The decrease in serum in group B and C was significantly lower than that in group A (P <0.05), while in group B and C, After enteral nutrition decreased significantly than the C group, the difference was statistically significant (P <0.05). The infection rates, fatality rates, complication rates, hospital stay and hospitalization costs in group B and C were significantly lower than those in group A (P <0.05). The infection rates, mortality and complication rates in group B and C were significantly lower than those in group B Obviously lower than C group (P <0.05). Conclusion: Early enteral nutrition can improve the early inflammatory response in acute severe pancreatitis, thus reducing the infection rate, mortality and complication rate. In patients with stable cycling conditions, the sooner the enteral nutrition is administered, the better the patient’s prognosis.