Influence of early enteral nutrition combined with gut barrier protection mixture on gut barrier function of patients with severe acute pancreatitis
- Author:
- No author available
- Journal Title:
- CHINESE JOURNAL OF PANCREATOLOGY
- Issue:
- 3
- DOI:
- 10.3760/cma.j.issn.1674-1935.2004.03.008
- Key Word:
- 肠营养;胰腺炎;急性病;肠屏障
Abstract： 目的初步探讨持续性早期肠内营养(enteral nutrition, EN)联合肠屏障保护合剂对重症急性胰腺炎(severe acute pancreatitis, SAP)患者肠屏障功能障碍的影响.方法选择10例SAP患者,入院后48 ～ 72 h后经空肠予以持续性肠内营养配合常规治疗,观察患者一般情况、腹部症状及体征并行APACHE-Ⅱ评分.治疗前及治疗后每隔1周检测血清淀粉酶、白蛋白、转铁蛋白、CRP、肿瘤坏死因子-α、白介素-1β及血浆内毒素、D-乳酸(D-lactate)、二胺氧化酶(diamine oxidase, DAO)浓度.治疗前及治疗后每隔1周予SAP患者肠通透性测试液(内含乳果糖2 g、甘露醇1 g)后,留取6 h尿液,检测尿液乳果糖/甘露醇比值.每隔2周行腹部CT扫描复查胰腺形态学变化.治疗前及治疗后每隔1周留取粪便,提取粪便总DNA,获得反映肠道菌群组成特征的(enterobacterial repetitive intergenic consensus, ERIC)指纹图谱.结果 (1)10例患者都能较好地耐受肠内营养的实施,无人发生腹胀、腹泻、呕吐等不良反应.除1人有糖尿病史而发生酮症酸中毒外,无人发生高血糖及高脂血症.(2)患者APACHE-Ⅱ评分逐渐下降,CT扫描显示胰腺组织坏死区域范围显著缩小,胰周渗出吸收明显.1例患者在疾病后期因胰腺组织感染而行手术治疗,其余患者无人发生胰腺及胰外组织感染,无人发生多脏器功能障碍,最后均治愈出院.(3)患者血清白蛋白及转铁蛋白水平由治疗前低于正常值至经EN治疗后逐渐升高.(4)患者血浆D-乳酸、DAO水平及尿乳果糖/甘露醇于EN治疗后明显下降,并随着时间的延长而呈逐渐下降趋势,差异显著.(5)患者血浆内毒素浓度于EN治疗后明显下降,并随着时间的延长而逐渐下降.(6)血清TNF-α和IL-1β由治疗前的峰值至经治疗后逐渐下降.(7)SAP治疗前及治疗后第7、14天,患者优势ERIC条带数目、结构分布大致相似,无显著变化. 结论 EN能改善SAP患者营养状况.SAP时实施EN联合肠屏障保护合剂安全可行,有助于保护SAP患者肠屏障功能,减少内毒素移位,减轻全身炎症反应.
- [1]王兴鹏,吴恺,王冰娴,等.谷氨酰胺对急性坏死型胰腺炎大鼠肠道衰竭的治疗作用[J].2001,(12).
- [2]姚咏明,盛志勇,吴叶.大鼠急性肠缺血后血浆D-乳酸的变化及其与肠粘膜损害的关系[J].1998,(4).
- [3]徐德征,胡铭荣.胆酸钠、乳果糖、山莨菪碱对梗阻性黄疸内毒素血症的临床治疗观察[J].2000,006 (6).
- [4]R B, Brandt,S A, Siegel,M G, Waters,etc.Spectrophotometric assay for D-(-)-lactate in plasma.[J].1980,102.
- [5]Berber E,Ozarmagan S,Erbil Y,etc.The effects of sodium deoxycholate, lactulose and glutamine on bacterial translocation in common bile duct ligated rats.[J].1999,46(29).
- [6]J S, Scolapio,N, Malhi-Chowla,A, Ukleja.Nutrition supplementation in patients with acute and chronic pancreatitis.[J].1999,28(3).
- [7]Eckerwall G,Andersson R.Early enteral nutrition in severe acute pancreatitis: a way of providing nutrients, gut barrier protection, immunomodulation, or all of them?[J].2001,36(5).
- [8]黎君友,于燕,郝军,等.分光光度法测定血和小肠组织二胺氧化酶活性[J].1996,(4).
- [9]刘卫,蒋朱明,舒红.正常国人乳果糖和甘露醇排出率比值[J].1999,(5).