小儿急性胰腺炎序贯化营养支持与肠外营养支持的疗效比较

doi:10.11958/20231850

摘要/Abstract

摘要：

目的探讨序贯化营养支持与肠外营养支持对小儿急性胰腺炎的临床干预效果。方法回顾性收集102例急性胰腺炎患儿资料，根据肠外营养支持方式分为肠外营养组和序贯化营养组，各51例。分析2组在干预前、干预14 d后的营养状况[血清白蛋白（ALB）、总蛋白（TP）、前白蛋白（PA）、血淀粉酶（AMS）及尿淀粉酶（UAMY）水平]，流式细胞仪检测细胞免疫指标（CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺），免疫散射比浊法检测体液免疫指标[免疫球蛋白A（IgA）、IgG、IgM]，比较2组机体康复指标（腹胀缓解时间、经口进食恢复时间、体温恢复正常时间、血及尿淀粉酶恢复时间、住院时间）差异。结果与干预前比较，干预后2组营养状况、细胞和体液免疫及机体康复指标均有所改善（P<0.05），与肠外营养组比较，干预后序贯化营养组3类指标改善更为明显（P<0.05），腹胀缓解时间、经口进食恢复时间、体温恢复正常时间、血及尿淀粉酶恢复时间、住院时间均短于肠外营养组（P<0.05）。结论序贯化营养支持相较于肠外营养支持可有效改善急性胰腺炎患儿营养状况，提升免疫功能，促进机体康复。

关键词: 胰腺炎, 急性坏死性, 胃肠外营养, 儿童, 序贯化营养支持, 免疫功能

Abstract:

Objective To compare and analyze the effectiveness of sequential nutritional support and parenteral nutrition support in clinical intervention of pediatric acute pancreatitis. Methods Data of 102 children with acute pancreatitis were retrospectively collected and divided into the parenteral nutrition group (n=51) and the sequential nutrition group (n=51) based on the type of parenteral nutrition support. Changes in nutritional status, immune function indicators and body rehabilitation indicators were compared before and after intervention between two groups. The humoral immune indexes (IgA, IgG and IgM) were detected by immunonephelometry. The body recovery indexes (abdominal distension relief time, oral feeding recovery time, body temperature recovery time, blood and urine amylase recovery time and hospital stay) were compared between the two groups. Results After intervention, levels of serum albumin, total protein and prealbumin were higher in the study group than those in the control group, while levels of blood amylase and urine amylase were lower than those in the control group (P<0.05). After intervention, the CD3⁺, CD4⁺ and CD4⁺/CD8⁺indicators were higher in the study group than those in the control group (P<0.05). After intervention, IgA, IgG and IgM indicators were higher in the study group than those in the control group (P<0.05). The relief time of abdominal distension, recovery time of oral feeding, recovery time of body temperature, recovery time of blood and urine amylase and hospitalization time were all shorter in the study group than those in the control group (P<0.05). Conclusion Sequential nutritional support can effectively improve the nutritional status of children with acute pancreatitis, enhance immune function and promote physical recovery compared to parenteral nutrition support.

Key words: pancreatitis, acute necrotizing, parenteral nutrition, child, sequential nutritional support, immunologic function

中图分类号:

R725.761，R459.3

图/表 4

参考文献 20

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组别		ALB/（g/L）				TP/（g/L）
组别		干预前		干预后	t	干预前		干预后	t
肠外营养组		31.08±2.68		35.24±3.52	6.715^＊＊	55.39±9.28		75.36±8.92	11.080^＊＊
序贯化营养组		31.19±2.74		40.88±4.03	7.265^＊＊	55.01±9.51		83.71±9.05	15.142^＊＊
t		0.205		7.527^＊＊		0.204		4.693^＊＊
组别	PA/（g/L）			AMS/（U/L）			UAMY/（U/L）
组别	干预前	干预后	t	干预前	干预后	t	干预前	干预后	t
肠外营养组	146.27±17.04	202.09±18.41	15.891^＊＊	1 012.35±120.69	292.06±15.03	42.294^＊＊	1 737.37±284.06	425.16±32.28	32.779^＊＊
序贯化营养组	145.94±16.92	268.02±19.93	18.627^＊＊	1 018.72±125.93	186.15±18.05	56.231^＊＊	1 715.84±290.18	343.06±29.75	36.582^＊＊
t	0.098	17.354^＊＊		0.261	32.201^＊＊		0.379	13.356^＊＊

组别		ALB/（g/L）				TP/（g/L）
组别		干预前		干预后	t	干预前		干预后	t
肠外营养组		31.08±2.68		35.24±3.52	6.715^＊＊	55.39±9.28		75.36±8.92	11.080^＊＊
序贯化营养组		31.19±2.74		40.88±4.03	7.265^＊＊	55.01±9.51		83.71±9.05	15.142^＊＊
t		0.205		7.527^＊＊		0.204		4.693^＊＊
组别	PA/（g/L）			AMS/（U/L）			UAMY/（U/L）
组别	干预前	干预后	t	干预前	干预后	t	干预前	干预后	t
肠外营养组	146.27±17.04	202.09±18.41	15.891^＊＊	1 012.35±120.69	292.06±15.03	42.294^＊＊	1 737.37±284.06	425.16±32.28	32.779^＊＊
序贯化营养组	145.94±16.92	268.02±19.93	18.627^＊＊	1 018.72±125.93	186.15±18.05	56.231^＊＊	1 715.84±290.18	343.06±29.75	36.582^＊＊
t	0.098	17.354^＊＊		0.261	32.201^＊＊		0.379	13.356^＊＊

组别	CD3⁺/%			CD4⁺/%
组别	干预前	干预后	t	干预前	干预后	t
肠外营养组	50.31±6.28	59.02±7.03	6.599^＊＊	31.03±6.33	40.06±6.26	7.244^＊＊
序贯化营养组	50.59±6.42	67.15±6.89	8.692^＊＊	30.79±6.47	45.18±5.77	8.657^＊＊
t	0.223	5.898^＊＊		0.189	4.295^＊＊
组别	CD8⁺/%			CD4⁺/CD8⁺
组别	干预前	干预后	t	干预前	干预后	t
肠外营养组	19.68±3.79	21.94±4.02	2.921^＊	1.44±0.59	1.89±0.48	4.225^＊＊
序贯化营养组	20.01±3.58	22.13±3.96	3.562^＊＊	1.47±0.61	2.25±0.52	5.568^＊＊
t	0.452	0.240		0.252	3.633^＊＊

组别	CD3⁺/%			CD4⁺/%
组别	干预前	干预后	t	干预前	干预后	t
肠外营养组	50.31±6.28	59.02±7.03	6.599^＊＊	31.03±6.33	40.06±6.26	7.244^＊＊
序贯化营养组	50.59±6.42	67.15±6.89	8.692^＊＊	30.79±6.47	45.18±5.77	8.657^＊＊
t	0.223	5.898^＊＊		0.189	4.295^＊＊
组别	CD8⁺/%			CD4⁺/CD8⁺
组别	干预前	干预后	t	干预前	干预后	t
肠外营养组	19.68±3.79	21.94±4.02	2.921^＊	1.44±0.59	1.89±0.48	4.225^＊＊
序贯化营养组	20.01±3.58	22.13±3.96	3.562^＊＊	1.47±0.61	2.25±0.52	5.568^＊＊
t	0.452	0.240		0.252	3.633^＊＊

组别	IgA			IgG			IgM
组别	干预前	干预后	t	干预前	干预后	t	干预前	干预后	t
肠外营养组	2.09±0.24	2.20±0.23	2.363^＊＊	9.16±0.82	9.55±0.86	2.344^＊	0.82±0.21	0.94±0.13	3.470^＊＊
序贯化营养组	2.11±0.25	2.33±0.26	4.356^＊＊	9.20±0.80	9.92±0.83	4.460^＊＊	0.81±0.28	1.27±0.17	10.029^＊＊
t	0.412	2.674^＊＊		0.122	2.211^＊		0.204	11.012^＊＊