谷氨酰胺联合早期肠内营养对急性重症胰腺炎全身炎症的影响分析
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摘要
目的分析和观察急性重症胰腺炎全身炎症患者以谷氨酰胺联合早期肠内营养方式治疗产生的效果。方法选取某院2015年1月-2017年6月收治的187例急性重症胰腺炎全身炎症患者为观察对象,在电脑随机分组下形成对照组和观察组,两组分别为93例和94例,给予对照组患者实施全肠外营养(Total Parenteral Nutrtion,TPN)方式治疗,观察组实施谷氨酰胺联合早期肠内营养方式治疗,而后分析和对比两组患者治疗的效果和影响。结果观察组患者经过治疗后,总胆红素、血尿素氮、APACHEⅡ评分分别为13.5±1.6μmol/L、4.2±1.3mmol/L、4.9±1.1分,C反应蛋白、TNF-α、IL-1β分别为1.1±0.4、8.4±1.7、0.10±0.03,ICU入住的时间以及期间发生的感染率分别为9.4±2.6天、31.91%,这两个方面均低于对照组,差异存在统计学意义(P<0.05)。结论对急性重症胰腺炎全身炎症患者实施谷氨酰胺联合早期肠内营养治疗可以有效改善患者炎症,并且可有效降低感染率以及减少住院时间。
Objective To analyze and observe the effect of glutamine combined with early enteral nutrition in acute severe pancreatitis patients with systemic inflammation. Methods A total of 187 patients with acute severe pancreatitis were enrolled in this study. From January 2015 to June 2017, 187 patients with acute severe pancreatitis were selected as the observation group. The control group and the observation group were randomly divided into two groups: 93 cases and 94 cases respectively. The patients in the control group were treated with parenteral nutrition(Total Parenteral Nutrtion,TPN), and the observation group was treated with glutamine and early enteral nutrition. The effects and effects of the two groups were analyzed and compared. Results After treatment, the levels of total bilirubin, blood urea nitrogen and APACHE Ⅱ were 13.5±1.6μmol/L, 4.2±1.3 mmol/L, 4.9±1.1, C-reactive protein, TNF-α, IL-1β were 1.1±0.4, 8.4±1.7 and 0.10±0.03 respectively. The time of ICU stay and the infection rate were 9.4±2.6 days and 31.91%, respectively. These two aspects were lower than the control group, the difference was statistically significant(P<0.05). Conclusion Glutamine combined with early enteral nutrition therapy can improve the inflammation of patients with acute severe pancreatitis and reduce the infection rate and reduce the hospitalization time.
Objective To analyze and observe the effect of glutamine combined with early enteral nutrition in acute severe pancreatitis patients with systemic inflammation. Methods A total of 187 patients with acute severe pancreatitis were enrolled in this study. From January 2015 to June 2017, 187 patients with acute severe pancreatitis were selected as the observation group. The control group and the observation group were randomly divided into two groups: 93 cases and 94 cases respectively. The patients in the control group were treated with parenteral nutrition(Total Parenteral Nutrtion,TPN), and the observation group was treated with glutamine and early enteral nutrition. The effects and effects of the two groups were analyzed and compared. Results After treatment, the levels of total bilirubin, blood urea nitrogen and APACHE Ⅱ were 13.5±1.6μmol/L, 4.2±1.3 mmol/L, 4.9±1.1, C-reactive protein, TNF-α, IL-1β were 1.1±0.4, 8.4±1.7 and 0.10±0.03 respectively. The time of ICU stay and the infection rate were 9.4±2.6 days and 31.91%, respectively. These two aspects were lower than the control group, the difference was statistically significant(P<0.05). Conclusion Glutamine combined with early enteral nutrition therapy can improve the inflammation of patients with acute severe pancreatitis and reduce the infection rate and reduce the hospitalization time.
引文
[1]杨国祥,张万里,杜寒松,等.谷氨酰胺联合早期肠内营养对急性重症胰腺炎全身炎症的影响[J].中国生化药物杂志,2014,34(02):125-127.
[2]王振宁,卢晓敏.谷氨酰胺治疗急性重症胰腺炎患者的疗效及对炎性细胞因子与肝功能的影响[J].医学综述,2016,22(12):2434-2437.
[3]Xiaodong Du,Yu Cao,Ping Xue,et al.Protective effect of intermedin on myocardial cell in a rat model of severe acute pancreatitis[J].Cellular and Molecular Biology Letters,2011,16(3):462-476.
[4]Dirk Roggenbuck,Alexander Goihl,Katja Hanack,et al.Serological diagnosis and prognosis of severe acute pancreatitis by analysis of serum glycoprotein 2[J].Clinical Chemistry and Laboratory Medicine(CCLM),2016,55(6):854-864.
[5]Yoko Yashima,Hiroyuki Isayama,Takeshi Tsujino,et al.A large volume of visceral adipose tissue leads to severe acute pancreatitis[J].Journal of Gastroenterology,2011,46(10):1213-1218.
[6]王中英.不同营养支持方式对重症急性胰腺炎患者血清CRP及血浆内毒素水平的影响[J].中国中西医结合消化杂志,2015,23(06):411-413+417.
[7]朱宏波,章华萍,潘田君.早期百普力肠内营养支持对重症急性胰腺炎的影响[J].世界华人消化杂志,2017,25(01):71-76.
[8]白黎智,康利民,路小光,等.肠内免疫微生态营养对重症急性胰腺炎肝损害的影响[J].世界华人消化杂志,2010,18(06):616-620.
[9]Lee Ho-Su,Lee Sung Koo,Park Do Hyun,et al.Emergence of multidrug resistant infection in patients with severe acute pancreatitis.[J].Pancreatology:official journal of the International Association of Pancreatology(IAP)...[et al.],2014,14(6):450-453.
[10]瓦永禄.早期肠内复方谷氨酰胺在重症急性胰腺炎治疗中的应用疗效[J].世界华人消化杂志,2015,23(09):1484-1488.
[11]朱妍,王志勤,林兆奋.谷氨酰胺联合早期肠内营养对急性重症胰腺炎患者氨基酸代谢、细菌移位以及炎症反应的影响[J].海南医学院学报,2015,21(03):347-349+352.
[12]范春梅.肠内营养在重症急性胰腺炎治疗中疗效观察的meta分析[D].延安大学,2013.
[13]李慎美.重症急性胰腺炎病人早期应用谷氨酰胺肠内营养的研究[D].辽宁医学院,2013.
[14]邹云良,黎德庆,陈建良.L-谷氨酰胺呱仑酸钠治疗重症急性胰腺炎的临床疗效研究[J].中国中西医结合消化杂志,2015,23(03):199-201.
[15]Flora K.Szabo,Lindsey Hornung,Judy-April Oparaji,et al.A prognostic tool to predict severe acute pancreatitis in pediatrics[J].Pancreatology,2016,16(3):358-364.
[16]Zhi-Bing Ou,Chun-Mu Miao,Ming-Xin Ye,et al.Investigation for role of tissue factor and blood coagulation system in severe acute pancreatitis and associated liver injury[J].Biomedicine&Pharmacotherapy,2016,10(3):380.
[17]谈志军.肠内营养与全胃肠外营养对重症急性胰腺炎患者营养及预后状况的差异性分析[J].中国中西医结合消化杂志,2014,22(10):619-621.
[18]李进,王娟,徐艳琴.早期肠内营养加培菲康对重症急性胰腺炎患者血浆中炎症介质水平变化的效果[J].世界华人消化杂志,2014,22(36):5609-5614.
[19]Xiao-Xin Zhang,Li-Hui Deng,Wei-Wei Chen,et al.Circulating micro RNA-216 as a marker for the early identi fication of severe acute pancreatitis[J].The American Journal of the Medical Sciences,2017,353(2):178-186.
[20]Guotao Lu,Yiyuan Pan,Abudurexiti Kayoumu,et al.Indomethacin inhabits the NLRP3 inflammasome pathway and protects severe acute pancreatitis in mice[J].Biochemical and Biophysical Research Communications,2017,353(2):178-186.
[21]周祥慧,何继东,邱雄,等.肠内营养和全胃肠外营养比较在重症急性胰腺炎中应用的系统评价[J].世界华人消化杂志,2014,22(21):3153-3160.
[22]付云辉,文剑波,王桂良,等.早期肠内营养对重症急性胰腺炎患者细胞因子水平及内毒素的影响[J].世界华人消化杂志,2015,23(07):1174-1179.
[23]梁朝矿,黄承吨,孔祥伟.谷氨酰胺联合规范化早期肠内营养治疗对急性重症胰腺炎患者的疗效分析[J].临床医学工程,2016,23(04):505-507.
[2]王振宁,卢晓敏.谷氨酰胺治疗急性重症胰腺炎患者的疗效及对炎性细胞因子与肝功能的影响[J].医学综述,2016,22(12):2434-2437.
[3]Xiaodong Du,Yu Cao,Ping Xue,et al.Protective effect of intermedin on myocardial cell in a rat model of severe acute pancreatitis[J].Cellular and Molecular Biology Letters,2011,16(3):462-476.
[4]Dirk Roggenbuck,Alexander Goihl,Katja Hanack,et al.Serological diagnosis and prognosis of severe acute pancreatitis by analysis of serum glycoprotein 2[J].Clinical Chemistry and Laboratory Medicine(CCLM),2016,55(6):854-864.
[5]Yoko Yashima,Hiroyuki Isayama,Takeshi Tsujino,et al.A large volume of visceral adipose tissue leads to severe acute pancreatitis[J].Journal of Gastroenterology,2011,46(10):1213-1218.
[6]王中英.不同营养支持方式对重症急性胰腺炎患者血清CRP及血浆内毒素水平的影响[J].中国中西医结合消化杂志,2015,23(06):411-413+417.
[7]朱宏波,章华萍,潘田君.早期百普力肠内营养支持对重症急性胰腺炎的影响[J].世界华人消化杂志,2017,25(01):71-76.
[8]白黎智,康利民,路小光,等.肠内免疫微生态营养对重症急性胰腺炎肝损害的影响[J].世界华人消化杂志,2010,18(06):616-620.
[9]Lee Ho-Su,Lee Sung Koo,Park Do Hyun,et al.Emergence of multidrug resistant infection in patients with severe acute pancreatitis.[J].Pancreatology:official journal of the International Association of Pancreatology(IAP)...[et al.],2014,14(6):450-453.
[10]瓦永禄.早期肠内复方谷氨酰胺在重症急性胰腺炎治疗中的应用疗效[J].世界华人消化杂志,2015,23(09):1484-1488.
[11]朱妍,王志勤,林兆奋.谷氨酰胺联合早期肠内营养对急性重症胰腺炎患者氨基酸代谢、细菌移位以及炎症反应的影响[J].海南医学院学报,2015,21(03):347-349+352.
[12]范春梅.肠内营养在重症急性胰腺炎治疗中疗效观察的meta分析[D].延安大学,2013.
[13]李慎美.重症急性胰腺炎病人早期应用谷氨酰胺肠内营养的研究[D].辽宁医学院,2013.
[14]邹云良,黎德庆,陈建良.L-谷氨酰胺呱仑酸钠治疗重症急性胰腺炎的临床疗效研究[J].中国中西医结合消化杂志,2015,23(03):199-201.
[15]Flora K.Szabo,Lindsey Hornung,Judy-April Oparaji,et al.A prognostic tool to predict severe acute pancreatitis in pediatrics[J].Pancreatology,2016,16(3):358-364.
[16]Zhi-Bing Ou,Chun-Mu Miao,Ming-Xin Ye,et al.Investigation for role of tissue factor and blood coagulation system in severe acute pancreatitis and associated liver injury[J].Biomedicine&Pharmacotherapy,2016,10(3):380.
[17]谈志军.肠内营养与全胃肠外营养对重症急性胰腺炎患者营养及预后状况的差异性分析[J].中国中西医结合消化杂志,2014,22(10):619-621.
[18]李进,王娟,徐艳琴.早期肠内营养加培菲康对重症急性胰腺炎患者血浆中炎症介质水平变化的效果[J].世界华人消化杂志,2014,22(36):5609-5614.
[19]Xiao-Xin Zhang,Li-Hui Deng,Wei-Wei Chen,et al.Circulating micro RNA-216 as a marker for the early identi fication of severe acute pancreatitis[J].The American Journal of the Medical Sciences,2017,353(2):178-186.
[20]Guotao Lu,Yiyuan Pan,Abudurexiti Kayoumu,et al.Indomethacin inhabits the NLRP3 inflammasome pathway and protects severe acute pancreatitis in mice[J].Biochemical and Biophysical Research Communications,2017,353(2):178-186.
[21]周祥慧,何继东,邱雄,等.肠内营养和全胃肠外营养比较在重症急性胰腺炎中应用的系统评价[J].世界华人消化杂志,2014,22(21):3153-3160.
[22]付云辉,文剑波,王桂良,等.早期肠内营养对重症急性胰腺炎患者细胞因子水平及内毒素的影响[J].世界华人消化杂志,2015,23(07):1174-1179.
[23]梁朝矿,黄承吨,孔祥伟.谷氨酰胺联合规范化早期肠内营养治疗对急性重症胰腺炎患者的疗效分析[J].临床医学工程,2016,23(04):505-507.