摘要
目的探讨早期空肠营养（EN）对重症急性胰腺炎（SAP）胰外分泌功能的影响，以及联合胰管引流术对SAP的疗效和安全性。方法日本大耳白兔24只，随机分为全胃肠外营养（TPN）组、空肠营养（EN）组、空肠营养联合胰管引流（EN＋PD）组、假手术（S）组，每组6只。前三组采用胰管结扎联合胆汁注射的方法制成兔SAP模型。造模后4、8、16h、第1、4、7天测定淀粉酶的含量；第7天收集胰腺、肝脏、肺，HE染色观察其组织病理学；54例SAP患者，在施行急诊鼻胰引流术后，随机分为EN组（30例）和TPN组（24例），EN组行空肠营养。收集第1、4、7天的胰液检测胰弹力蛋白酶（PE—1）和淀粉酶（AMY）的含量，检测两组患者第1、4、7、11、15天血淀粉酶、血PE—1的含量，观察SAP患者的住院时间、住院费用、治愈率。结果兔TPN组、EN组、EN＋PD组实验前后淀粉酶差异具有统计学意义，实验后8h达高峰，第4天基本降至正常水平；TPN组、EN组、EN＋PD组之间比较淀粉酶差异无统计学意义（P〉0．05）。胰腺、肺、肝的病理学改变以TPN组最明显，EN、EN＋PD组相对程度减轻。EN和TPN组患者的住院时间、腹痛缓解时间、治愈率两组相比，差异具有统计学意义（P〈0．05）。胰液的PE—1、AMY以及血PE-1、AMY两组相比无统计学意义（P〉0．05）。结论SAP施行空肠营养不影响胰腺的外分泌功能，早期空肠营养联合鼻胰引流是比较安全和有效的治疗SAP的方法。
Objective To evaluate the effect of early enteral nutrition （EN） on pancreatic exocrine function in rabbits and patients with severe acute pancreatitis （SAP）, and therapeutic efficacy and safety of EN combined with pancreatic drainage. Method Twenty-four experimental rabbits were randomly divided into four groups, total parenteral nutrition （TPN） group, enteral nutrition （ EN）, enteral nutrition combined pancreatic drainage （EN ＋ PD） group, sham-operation （S） group. SAP model was induced by ligating pancreatic duct and injecting bile. The levels of amylase were determined at 4, 8, 16 hours and 1, 4, 7 days following SAP. Specimens of tissue from pancreas, liver, lung were taken at the 7^th day, and pancreas pathology was observed. Fifty-four Patients with SAP were divided into EN group （ n = 30 ） and TPN （ n = 24） after urgent treatment by endoscopically nasopancreatic drainage. EN group were given enteral nutrition via nasojejunal tube following admission 48 to 72 hours. Pancreatic juice was collected following 1, 4, 7 days and its pancreatic elastase-1 （PE- 1 ）, amylase （AMY） were determined as well as serum concentration of amylase, PE-1, incidence of remission, hospital stay, and costs betwen were compared between two groups. Results The levels of AMY were significant difference, experimental rabbits in TPN, EN, EN ＋ PD group both pre and post-experiment. Concentration of AMY reached maximum after 8 hours and decreased to normality. The levels of AMY and pathologic feature of pancreas were no significant difference between rabbits of TPN, EN, EN ＋ PD groups （ P 〉 0.05）. The change of pancreas, liver, and lung pathology in TPN group was more abvious than EN, and ENPD groups. The days of hospital stay, relief of abdomen pain, and curative rate in patients with SAP were significant difference between two groups （ P 〈 0.05）. The levels of PE-1, and AMY in pancreatic juice and the concentration of serum PE-1, AMY were no significant difference （ P 〉 0.05）. Conclusions Concerns that EN promotes pancreatic exocrine function in SAP are unfounded. Combined with pancreatic drainage, it was safe and effective management.
出处
《中华急诊医学杂志》
CAS
CSCD
2007年第4期378-382,共5页
Chinese Journal of Emergency Medicine
关键词
空肠营养
胰管引流
重症急性胰腺炎
胰腺外分泌
Enteral nutrition
Endoscopic nasopancreatic drainage
Severe acute pancreatitis
Pancreatic exocrine
