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

摘要：

目的　探究肠内营养（EN）联合连续性血液净化（CBP）对重症急性胰腺炎患者腹痛缓解、感染率和炎症指标的影响。方法　选取2020年4月至2023年3月西安市第九医院收治的80例重症急性胰腺炎患者，按诊疗时间顺序分为对照组（40例）和观察组（40例）。对照组男22例，女18例；年龄20～67（48.42±12.84）岁；病程3～28（6.84±1.28）h；采用CBP治疗。观察组男23例，女17例；年龄21～66（48.34±12.93）岁；病程3～29（6.91±1.34）h；采用EN联合CBP治疗。记录并比较两组症状缓解情况，治疗前和治疗72 h后炎症因子水平［白细胞介素-6（IL-6）、IL-8、血清肿瘤坏死因子-α（TNF-α）］和胃肠功能指标［血浆D-乳酸、尿乳果糖/甘露醇（L/M）值］变化情况，以及治疗期间感染发生情况。采用独立样本t检验、配对样本t检验和χ²检验。结果　治疗后，观察组患者的腹痛缓解时间［（2.14±0.44）d］、腹胀缓解时间［（3.63±0.96）d］和肛门排气时间［（3.39±1.03）d］均短于对照组，差异均有统计学意义（均P<0.05）。治疗72 h后，两组炎症因子水平均低于治疗前，且观察组IL-6［（68.67±12.04）ng/L］、IL-8［（72.63±14.13）ng/L］，TNF-α［（10.07±1.59）ng/L］水平均低于对照组，差异均有统计学意义（均P<0.05）。治疗72 h后，两组胃肠功能指标均低于治疗前，且观察组D-乳酸［（6.37±1.06）μg/L］和尿L/M［（0.05±0.01）g/g］均低于对照组，差异均有统计学意义（均P<0.05）。治疗期间，两组感染总发生率比较，差异无统计学意义（P>0.05）。结论　EN联合CBP治疗，不仅可以改善重症急性胰腺炎患者的肠胃功能，减轻炎症反应，还具有良好的安全性。

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