目的: 研究重症急性胰腺炎（severe acute pancreatitis, SAP）发病早期不同时间启动肠内营养（enteral nutrition,EN）对其病情及临床预后的影响。方法: 本研究回顾 2013年1月至2016年12月我院急诊重症监护室收治的174例SAP病人。筛选纳入后,按发病后EN启动时间分为A组（5 d内启动EN）和B组（5~14 d内启动EN）。分析两组治疗前后APACHE Ⅱ评分、SOFA评分、住院时间、手术率、死亡率和并发症发生。结果: 174例SAP病人经筛选,最终纳入98例。其中,A组51例,B组47例。入院当天,A、B两组病人APACHEⅡ评分、SOFA评分差异均无统计学意义（P>0.05）。治疗后14 d及28 d,两组APACHEⅡ评分、SOFA评分均明显低于入院当天,且同期A组评分明显低于B组（P<0.05）,发病28 d评分与入院当天相比,SOFA评分下降程度有统计学差异（P<0.05）。A组病人入院后急性肾损伤（acute kidney injury,AKI）发生率、手术率及发病60 d死亡率显著低于B组（P<0.05）,而总住院时间、发病28 d死亡率及其他并发症（急性呼吸窘迫综合征、脓毒症、腹腔间隔室综合征、胰腺假性囊肿）发生率无统计学差异（P>0.05）。结论: 发病5 d内启动早期EN较5 d后启动可降低SAP病人的手术率、AKI发生率及发病60 d死亡率,能降低APACHE Ⅱ评分以及SOFA评分,且对SOFA评分改善程度更大。建议临床早期对SAP病人行EN支持。
周磊, 陈影, 姚怿, 赵冰, 杨之涛, 车在前, 费健, 盛慧球, 毛恩强, 陈尔真
. 早期肠内营养时间影响重症急性胰腺炎病人预后的回顾研究[J]. 外科理论与实践, 2019
, 24(01)
: 55
-59
.
DOI: 10.16139/j.1007-9610.2019.01.012
Objective To investigate the effect of early enteral nutrition (EN) at different time points on the clinical outcomes of severe acute pancreatitis (SAP). Methods A total of 174 patients with SAP admitted from January 2013 to December 2016 were studied retrospectively. The cases after screening were divided into group A (<5 d) and group B（5-14 d）in the final analysis according to the initial time of EN. They were analyzed for change in acute physiology and chronic health evaluation (APAHCE) Ⅱ score and sequential organ failure assessment (SOFA) score, length of hospital stay, operative rate, mortality and complications rate including acute kidney injury (AKI), acute respiratory distress syndrome, sepsis, abdominal compartment syndrome and pancreatic pseudocyst. Results A total of 98 cases were included finally. Fifty-one cases were in group A and 47 in group B. On the day of admission, there was no significant difference in APACHE Ⅱ score and SOFA score between 2 groups (P>0.05). APACHE Ⅱ scores and SOFA scores of cases in 2 groups were significantly lower on day 14 and 28 compared to those on admission day (P<0.05) and those scores on day 14 and 28 in group A were lower than in group B. On day 28, the reduction of SOFA score was significantly greater in group A than that in group B (P<0.05). The significant lower rate of acute kidney injury (AKI) in group A was found when compared with that in group B (P<0.05), but no difference was present in the rates of other complication including acute respiratory distress syndrome, sepsis, abdominal compartment syndrome and pancreatic pseudocyst(P>0.05). The cases in group A had significantly lower operative rate and lower 60-day mortality compared with those in group B (P<0.05). However, the difference in length of hospital stay and 28-day mortality was not seen between 2 groups (P>0.05). Conclusions The different time points patients with SAP initiated early EN within 5 days of admission had lower rate of AKI, lower operative rate and lower 60-day mortality compared with those initiated EN after 5 days. Early initiation of EN within 5 days also significantly reduced APACHE Ⅱ score and SOFA score, in which the decrease of SOFA score was more prominent. It recommends to start EN early in patients with SAP.
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