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目的探讨重症急性胰腺炎(SAP)术后早期实施肠内营养(EN)的时机及效果。方法将2009年6月至2014年6月纳入研究的58例SAP术后患者随机分成两组,早期EN组(EEN组,29例)及对照组(29例)。两组常规治疗方法相同,EEN组术后48 h开始加用EN,对照组术后第5天开始加用EN。观察两组患者术后5 h、72 h、第6天及第10天血清C反应蛋白(CRP)、血清钙、腹腔内压及腹腔引流液量等指标变化情况。结果 EEN组与对照组患者CRP在术后5 h均明显升高,术后72 h开始下降,第6天及第10天呈明显下降趋势,EEN组下降比对照组更明显(P<0.05,P<0.01)。两组患者在术后5、72 h血清钙离子均低于正常水平,术后第6天及第10天均呈升高趋势,同期比较,EEN组较对照组升高更明显(P均<0.05)。两组腹腔内压第6天、第10天明显下降,EEN组比对照组下降更明显(P<0.05)。EEN组在术后第10天腹腔引流量较对照组明显减少(P<0.01)。结论 SAP患者术后48 h开始EEN可减轻炎症反应,降低感染的风险,减少后期并发症,有利于胃肠功能的恢复,安全可行。
Objective To investigate the timing and effect of early enteral nutrition (EN) after severe acute pancreatitis (SAP). Methods Fifty-eight patients with SAP who were included in the study from June 2009 to June 2014 were randomly divided into two groups: early EN group (29 cases) and control group (29 cases). The two groups were treated in the same way. EN was added 48 hours after operation in EEN group and EN was added on day 5 after operation in control group. The changes of serum C-reactive protein (CRP), serum calcium, intra-abdominal pressure and peritoneal drainage volume at 5 h, 72 h, 6 d and 10 d after operation were observed. Results The levels of CRP in EEN group and control group were significantly increased at 5 hours and decreased at 72 hours after operation. The levels of CRP in EEN group and control group decreased significantly on the 6th day and the 10th day (P <0.05, P <0.01). Serum calcium levels were both lower than normal at 5 and 72 h after operation in both groups, and increased on the 6th day and the 10th day after the operation. Compared with the control group, the levels of serum calcium in the two groups increased more significantly (P < 0.05). The intraperitoneal pressure of both groups decreased significantly on the 6th day and the 10th day, the EEN group decreased more obviously than the control group (P <0.05). In the EEN group, the amount of abdominal drainage on the 10th day after operation was significantly lower than that of the control group (P <0.01). Conclusion EEN at 48 h after SAP can reduce inflammation, reduce the risk of infection and reduce late complications, which is beneficial to the recovery of gastrointestinal function and is safe and feasible.