目的：比较早期肠内营养与延迟肠内营养对重症急性胰腺炎（SAP）患者腹内高压及免疫功能的影响。方法选取2013年1月—2014年12月在皖南医学院附属弋矶山医院急诊内科就诊的 SAP 患者40例，按照随机数字表法将其分为观察组和对照组，各20例。在综合治疗的基础上，观察组患者入院48 h 后行肠内营养支持治疗，对照组患者在入院后5 d 予肠内营养支持。两组肠内营养支持干预疗程均为2周。分别记录两组治疗前后腹内压（IAP）及腹内高压发生率；检测两组治疗前后血清免疫球蛋白（ IgG、IgM、IgA）及外周血 T 淋巴细胞亚群（ CD +3、CD +4、CD +4/ CD +8）水平；记录两组治疗前后血淀粉酶、体质指数（BMI）及视觉模拟评分（ VAS）。结果两组患者治疗前 IAP比较，差异无统计学意义（P >0.05）；治疗后，观察组 IAP 低于对照组（P <0.05）；且两组患者 IAP 均低于同组治疗前（P <0.05）。两组患者第1天和第14天腹内高压发生率比较，差异均无统计学意义（P >0.05）；观察组第7天和第10天腹内高压发生率低于对照组（P <0.05）。治疗前，两组患者血清免疫球蛋白 IgG、IgM、IgA 及外周血 T 淋巴细胞亚群 CD +3、CD +4、CD +4/ CD +8水平比较，差异均无统计学意义（ P >0.05）；治疗后，观察组血清免疫球蛋白 IgG、IgM、IgA 及外周血 T 淋巴细胞亚群 CD +3、CD +4、CD +4/ CD +8水平均高于对照组（P <0.05）；两组治疗后血清免疫球蛋白 IgG、IgM、IgA 及外周血 T 淋巴细胞亚群 CD +3、CD +4、CD +4/ CD +8水平均高于同组治疗前（P <0.05）。治疗前，两组血淀粉酶、BMI 及 VAS 比较，差异均无统计学意义（P >0.05）；治疗后，观察组血淀粉酶、BMI 及 VAS 均低于对照组（P <0.05）；两组治疗后血淀粉酶、BMI 及 VAS 均较治疗前降低（P <0.05）。治疗过程中对照组患者有5例发生不良反应，观察组有3例发生不良反应，两组不良反应发生率比较，差异无统计学意义（χ2=0.625，P >0.05）。结论早期肠内营养可以明显降低 SAP 患者腹内高压发生率，调节并改善机体的免疫功能，从而改善患者的预后情况。%Objective To investigate the influence of early enteral nutrition and delayed enteral nutrition on the intra_ abdominal hypertension and immune function of patients with severe acute pancreatitis(SAP). Methods From January 2013 to December 2014,40 SAP patients who received treatment in Yijishan Hospital of Wannan Medical College were enrolled and divided into observation group and control group with 20 patients in each group. On the basis of comprehensive treatment,the patients in observation group began to receive support treatment by enteral nutrition 48 hours after admission,and the patients in control group began to receive the same support treatment by enteral nutrition 5 days after admission. The treatment course lasted for 2 weeks for both groups. The incidence rates of intra _ abdominal pressure and intra _ abdominal hypertension of the two groups before and after treatment were recorded. The levels of serum immunoglobulin(IgG,IgM and IgA)and levels of peripheral blood T lymphocyte subsets(CD +3 ,CD +4 and CD +4 / CD +8 )were detected. Blood amylase level,BMI and VAS of the two groups were recorded. Results The two groups were not significantly different in IAP before treatment(P > 0. 05),while the observation group was lower than control group in IAP(P < 0. 05). The two groups had lower IAP after treatment than that before treatment (P < 0. 05). The two groups were not significantly different in the incidence rate of intra _ abdominal hypertension on day 1 and day 14(P > 0. 05). The observation group was lower than control group in the incidence rate of intra _ abdominal hypertension on day 7 and day 10(P < 0. 05). Before treatment,the two groups were not significantly different in the levels of IgG,IgM and IgA and the levels of CD +3 ,CD +4 and CD +4 / CD +8 (P > 0. 05). After treatment,observation group was higher than control group in the levels of IgG,IgM and IgA and the levels of CD +3 ,CD +4 and CD +4 / CD +8 (P < 0. 05),and the two groups had higher levels of IgG,IgM and IgA and higher levels of CD +3 ,CD +4 and CD +4 / CD +8 after treatment than those before treatment(P <0. 05). Before treatment,the two groups were not significantly different in blood amylase level,BMI and VAS( P > 0. 05). After treatment,observation group was lower than control group in blood amylase level,BMI and VAS(P < 0. 05),and the two groups had lower blood amylase level,BMI and VAS than those before treatment( P < 0. 05). In the treatment process,5 patients had adverse reactions in control group and 3 patients had adverse reactions in observation group,with no significant differences between the two groups in the incidence rate of adverse reaction( χ2 = 0. 625,P > 0. 05). Conclusion Early enteral nutrition can significantly decrease the incidence rate of intra _ abdominal pressure and regulate and improve body immune function,thus improving prognosis.
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