关键词:

重症急性胰腺炎, 肠内营养, 连续性血液净化, 感染, 炎症因子

Abstract:

Objective　To investigate the effect of enteral nutrition combined with continuous blood purification on abdominal pain relief, infection rate, and inflammatory indexes in patients with severe acute pancreatitis. Methods　Eighty cases of severe acute pancreatitis admitted to Xi'an No.9 Hospital from April 2020 to March 2023 were selected as the study subjects, and they were divided into an observation group (40 cases) and a control group (40 cases) according to the order of the time of diagnosis and treatment. There were 22 males and 18 females in the control group, the age was 20-67 (48.42±12.84) years old, and the course of disease was 3-28 (6.84±1.28) h. There were 23 males and 17 females in the observation group, the age was 21-66 (48.34±12.93) years old, and the course of disease was 3-29 (6.91±1.34) h. The control group was treated with continuous blood purification, and the observation group was treated with enteral nutrition combined with continuous blood purification. Symptom relief, changes in inflammatory factors levels [interleukin-6 (IL-6), IL-8, and serum tumor necrosis factor-alpha (TNF-α)] and gastrointestinal function indexes [plasma D-lactic acid and urinary lactulose/mannitol (L/M) values] before and after treatment, and occurrence of infection during the treatment period were recorded and compared between the two groups. Independent sample t test, paired sample t test, and χ² test were used. Results　After treatment, the abdominal pain relief time [(2.14±0.44) d], abdominal distension relief time [(3.63±0.96) d], and anal exhaust time [(3.39±1.03) d] in the observation group were shorter than those in the control group, with statistically significant differences (all P<0.05). After 72 h of treatment, the levels of inflammatory factors in both groups were lower than those before treatment, and the levels of IL-6 [(68.67±12.04) ng/L], IL-8 [(72.63±14.13) ng/L], and TNF-α [(10.07±1.59) ng/L] in the observation group were lower than those in the control group, with statistically significant differences (all P<0.05). After 72 h of treatment, the gastrointestinal function indexes in both groups were lower than those before treatment, and the levels of D-lactic acid [(6.37±1.06) μg/L] and urinary L/M [(0.05±0.01) g/g] in the observation group were lower than those in the control group, with statistically significant differences (all P<0.05). During the treatment period, there was no statistically significant difference in the total occurrence of infection between the two groups (P>0.05). Conclusion　Enteral nutrition combined with continuous blood purification therapy not only improves the gastrointestinal function and reduces the inflammatory response in patients with severe acute pancreatitis, but also has a good safety profile.

Key words:

Severe acute pancreatitis, Enteral nutrition, Continuous blood purification, Infection, Inflammatory markers