强化谷氨酰胺的肠内营养联合微生态制剂对重症急性胰腺炎患者临床预后的影响

摘要

Objective It is to investigate the effects of enteral nutrition support adding glutamine combined with microecological preparations on the prognosis of patients with severe acute pancreatitis (SAP).Methods 78 patients with SAP were randomly divided into treatment group and control group,each group had 39 cases.All patients were treated with conventional treatment.Additionally,the control group was given parenteral nutrition support,the treatment group was given enteral nutrition adding glutamine combined with microecological preparations therapy through jejunal nutrient canal.The times of relief of abdominal signs (abdominal pain and distension) and recovery of laboratory indexes were compared,the changes of APACHE Ⅱ scores,nutrition indicators (serum ALB,PAB) and immune indexes (TLC,IgA,IgG,IgM) were observed after treatment in both groups.Results After treatment,the times of relief of abdominal pain and distension and recovery of blood and urine amylase were shorter in treatment group than that in control group (P ＜ 0.05).After treatment for 7,14 days,the APACHE Ⅱ scores were decreased while the levels of ALB and PAB were increased significantly in both groups (P ＜ 0.05),and the decrease or increase in treatment group was more obvious than that in control group(P ＜ 0.05).After treatment for 14 days,the levels of TLC,IgA,IgG,IgM were significantly increased in both groups,and the increase in treatment group was more significant than that of control group(P ＜0.05).Conclusion Enteral nutrition support adding glutamine combined with microecological preparations can more effectively relieve clinical symptoms,reduce inflammation reaction,improve the patient g nutritional status and immune function,thus to improve the clinical curative effect,it is worthy of wide application.%目的 探讨强化谷氨酰胺肠内营养支持联合微生态制剂对重症急性胰腺炎患者临床预后的影响.方法 将78例重症急性胰腺炎患者随机分为治疗组39例和对照组39例.2组均给予急性胰腺炎规范化治疗.在此基础上,对照组给予肠外营养支持;治疗组经空肠营养管给予强化谷氨酰胺肠内营养支持,同时配合使用微生态制剂.比较2组治疗后腹部体征(腹痛、腹胀)缓解时间和实验室指标(血、尿淀粉酶)恢复正常时间,并比较2组治疗后APACHEⅡ评分、营养指标[血清白蛋白(ALB)和血清前白蛋白(PAB)]及免疫指标[淋巴细胞总数(TLC)、血清IgA、IgG、IgM]的变化情况.结果 治疗后,治疗组腹痛、腹胀缓解时间及血、尿淀粉酶恢复正常时间均显著短于对照组(P均＜0.05);治疗7,14 d时2组APACHEⅡ评分均显著下降(P均＜ 0.05),且治疗组下降更明显(P均＜0.05);2组ALB和PAB水平均显著升高(P均＜0.05),且治疗组提高更为显著(P均＜0.05).治疗14 d时2组TLC、IgA、IgG、IgM水平均显著上升(P均＜0.05),且治疗组上升更显著(P均＜0.05).结论 强化谷氨酰胺肠内营养支持联合微生态制剂治疗重症急性胰腺炎能更加有效地缓解临床症状,减轻炎症反应,改善患者营养状况及免疫功能,从而提高临床疗效,值得推广应用.