摘要
目的探讨超早期肠内营养和早期肠内营养对老年急性重症胰腺炎(severe acute pancreatitis,SAP)的炎症介质和氧化应激的影响。方法选取2015年1月至2017年12月在我院就诊的老年SAP患者106例,根据随机数字方法,将患者分为观察组和对照组,每组各53例。观察组予以超早期肠内营养治疗,对照组予以早期肠内营养治疗。观察两组治疗前后症状、体征、血尿淀粉酶、APACHEⅡ、Ranson评分、炎症因子和氧化应激水平的变化。结果治疗后,观察组的腹痛缓解时间、腹胀缓解时间、肠鸣音恢复时间、恶心呕吐消失时间、排便排气恢复时间、发热消失时间和血象恢复时间明显短于对照组(P<0.05)。治疗后,观察组的腹腔感染、胆道感染、败血症、院内感染和消化道出血方面明显低于对照组(P<0.05)。两组治疗前血淀粉酶、尿淀粉酶、APACHEⅡ、Ranson评分、IL-8、IL-6、TNF-α、hs-CRP、MDA、GSH-Px、AOPP和SOD水平比较,差异无统计学意义(P>0.05);治疗后两组的血淀粉酶、尿淀粉酶、APACHEⅡ、Ranson评分、IL-8、IL-6、TNF-α、hs-CRP、MDA和AOPP水平较治疗前明显降低(P<0.01),而GSH-Px和SOD水平较治疗前明显升高(P<0.01),且观察组的降低或升高水平较对照组更为明显(P<0.01)。结论超早期肠内营养较早期肠内营养对老年SAP的疗效更加显著,恢复快、并发症少、对机体的炎症和氧化应激具有缓解作用。
Objective To investigate the effects of ultra-early enteral nutrition and early enteral nutrition on inflammatory mediators and oxidative stress in elderly patients with severe acute pancreatitis (SAP). Methods One hundred and six patients with SAP,from Jan.2015 to Dec.2017,were divided into observation group and control group,with 53 cases in each group according to the random number method.The observation group received ultra-early enteral nutrition,and control group received early enteral nutrition.The disappearance time of symptoms,signs,blood/urease amylase,APACHE Ⅱ,Ranson score,inflammatory factors and oxidative stress levels was observed before and after treatment. Results After treatment,the abdominal pain relief time,bloating relief time,bowel sound recovery time,nausea and vomiting disappearance time,defecation exhaust recovery time,fever disappearance time and blood recovery time were significantly shorter in observation group than those in control group ( P <0.05).After treatment,the incidence rate of abdominal infection,biliary tract infection,septicemia,nosocomial infection and gastrointestinal bleeding were significantly lower in observation group than those in control group ( P <0.05).There were no significant differences in serum amylase,urinary amylase,APACHE Ⅱ,Ranson score,IL-8,IL-6,TNF-α,hs-CRP,MDA,GSH-Px,AOPP and SOD between two groups ( P >0.05).After treatment,the levels of serum amylase,urinary amylase,APACHE Ⅱ,Ranson score,IL-8,IL-6,TNF-α,hs-CRP,MDA and AOPP were significantly lower in two groups than those before treatment ( P < 0.01 ),while GSH-Px and SOD levels were significantly higher than those before treatment ( P < 0.01 ),while the increasing and decreasing levels in observation group were more significantly obvious compared with control group ( P <0.01). Conclusion Ultra-early enteral nutrition is more effective in elderly patients with SAP compared with early enteral nutrition,with faster recovery,less complications,a mitigating effect on inflammation and oxidative stress in the body.
作者
杨琳
朱建宇
YANG Lin;ZHU Jianyu(Department of Nutrition,Shuguang Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200021,China)
出处
《胃肠病学和肝病学杂志》
CAS
2019年第7期811-815,共5页
Chinese Journal of Gastroenterology and Hepatology
关键词
急性重症胰腺炎
炎症介质
氧化应激
诊断
肠内营养
Severe acute pancreatitis
Inflammatory mediator
Oxidative stress
Diagnosis
Enteral nutrition
