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目的探讨肠内营养启动时机的不同对重症急性胰腺炎(SAP)预后的影响。方法回顾分析ICU 2012年1月至2014年12月收治的SAP 57例患者的临床资料,根据患者入院后48 h内能否启动肠内营养,将其分为早期肠内营养组(EEN组)30例,延迟肠内营养组(DEN组)27例。比较胰腺感染、胰腺假性囊肿、肺炎、呼吸衰竭、肾功能衰竭、MODS、菌血症、病死率、平均总住院时间、平均住ICU天数和住院平均总费用。结果 EEN组患者胰腺感染率(10.0%)明显低于DEN组(44.4%,P<0.05);EEN组患者肺炎、呼吸衰竭、MODS的发生率均明显低于DEN组(20.0%vs 48.1%,10.0%vs 33.3%,13.3%vs 44.4%,P均<0.05);且EEN组平均住院时间、平均住ICU天数、平均住院总费用均较DEN组明显减少(P均<0.05)。结论 SAP患者早期经鼻空肠管启动肠内营养,可以降低胰腺感染、肺炎、呼吸衰竭、MODS的发生,缩短住院时间,降低住院费用。
Objective To investigate the effect of different timing of enteral nutrition on the prognosis of severe acute pancreatitis (SAP). Methods The clinical data of 57 SAP patients admitted from January 2012 to December 2014 in the ICU were retrospectively analyzed. According to whether enteral nutrition could be started within 48 hours after admission, the patients were divided into early enteral nutrition group (EEN group) 30 cases, delayed enteral nutrition group (DEN group) 27 cases. Pancreatic infections, pancreatic pseudocysts, pneumonia, respiratory failure, renal failure, MODS, bacteremia, case fatality, mean total length of hospital stay, average number of days in ICU, and total hospitalization costs were compared. Results The infection rate of pneumonia, respiratory failure and MODS in EEN group was significantly lower than that in DEN group (10.0% vs 20.0% vs 48.1%, P <0.05) 10.0% vs33.3%, 13.3% vs44.4%, P <0.05). The mean length of hospital stay, average number of ICU days and total hospital stay in EEN group were significantly lower than those in DEN group (all P <0.05). Conclusions SAP can activate enteral nutrition in early nasal jejunum and reduce the incidence of pancreatic infection, pneumonia, respiratory failure and MODS, shorten the length of hospital stay and reduce the cost of hospitalization.