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目的评价不同时间的早期肠内营养(EN)支持在重症急性胰腺炎(SAP)治疗中的作用。方法回顾性分析36例SAP患者的临床资料。所有患者均给予常规治疗,并于SAP治疗后24~48 h、49~72 h、>72 h应用EN治疗,并据此分为A、B、C 3组。EN治疗第7天进行血清白蛋白(ALB)、血清前白蛋白(PA)、淋巴细胞计数(TLC)、白细胞计数、血清降钙素原(PCT)、C反应蛋白检查,记录首次排便时间、急性生理与慢性健康评分(APACHEⅡ)、Balthazar CT评分、腹胀缓解时间,统计胰周感染发生率、假性囊肿发生率、病死率、住院时间、住院费用等临床资料。结果A组12例,B组8例,C组16例。A组PA、TLC、白细胞计数、PCT、C反应蛋白、首次排便时间、腹胀缓解时间、假性囊肿发生率均显著优于C组(P<0.05)。A组ALB、PA、白细胞计数、C反应蛋白、住院时间显著优于B组(P<0.05)。结论对不同的治疗时间而言,SAP治疗后24~48 h进行EN治疗可能更有利于提高SAP的治疗效果。
Objective To evaluate the role of early enteral nutrition (EN) support at different times in the treatment of severe acute pancreatitis (SAP). Methods The clinical data of 36 SAP patients were retrospectively analyzed. All patients were given routine treatment and were treated with EN at 24-48 h, 49-72 h and> 72 h after SAP treatment, and were divided into A, B and C groups according to the results. On the seventh day after EN treatment, serum albumin (ALB), serum albumin (PA), lymphocyte count (TLC), white blood cell count, serum procalcitonin (PCT) and C-reactive protein were examined. APACHEⅡ, Balthazar CT score, abdominal distension time, the incidence of peripancreatic infection, the incidence of pseudocyst, case fatality rate, length of hospital stay, hospitalization expenses and other clinical data. Results A group of 12 cases, B group of 8 cases, C group of 16 cases. The PA, TLC, WBC count, PCT, C-reactive protein, first defecation time, abdominal distension time and the incidence of pseudocyst in group A were significantly better than those in group C (P <0.05). Group A ALB, PA, white blood cell count, C-reactive protein, hospital stay was significantly better than the B group (P <0.05). Conclusion For different treatment time, EN treatment 24-48 h after SAP treatment may be more conducive to improve the therapeutic effect of SAP.