摘要
目的 探讨重症胰腺炎患者早期肠内营养治疗前后肠黏膜屏障的变化及喂养不耐受危险因素.方法 选取2020年1月至2023年1月淮安市第二人民医院收治的80例重症胰腺炎患者进行回顾性分析.所有患者在入院后2～3 d均进行早期肠内营养治疗,比较治疗前与治疗7 d后前白蛋白、白蛋白、内毒素、二胺氧化酶(DAO)及D-乳酸水平变化.观察并记录80例患者早期肠内营养治疗过程中喂养不耐受发生情况,将患者分为喂养不耐受组(n=20)和喂养耐受组(n=60),比较两组年龄、性别、体重指数、高血脂、高血压、糖尿病、腹内压水平、血清白蛋白水平、中心静脉压(CVP)水平、是否出现肠鸣音、接受血液净化、机械通气治疗、急性生理学和慢性健康状况评价Ⅱ(APACHE Ⅱ)评分;采用多因素Logistic回归分析喂养不耐受的危险因素.结果 治疗7 d后,重症胰腺炎患者的前白蛋白、白蛋白相关营养指标水平分别为(298.54±56.52)mg/L、(37.33±4.21)g/L,均高于治疗前[(220.34±44.58)mg/L、(33.45±5.26)g/L],差异均有统计学意义(P＜0.05).治疗7 d后,重症胰腺炎患者的内毒素、DAO、D-乳酸相关肠黏膜屏障指标水平分别为(0.44±0.13)EU/mL、(82.15±11.34)mg/mL、(1.42±0.23)mmol/L,均低于治疗前[(0.96±0.16)EU/mL、(93.15±12.47)mg/inL、(2.15±0.28)mmol/L],差异均有统计学意义(P＜0.05).单因素分析显示,喂养耐受组与喂养不耐受组患者患者年龄、腹内压水平、白蛋白水平、CVP水平、接受机械通气治疗、APACHE Ⅱ评分比较,差异均有统计学意义(P＜0.05).多因素Logistics回归分析显示,年龄、腹内压、白蛋白、APACHE Ⅱ评分是喂养不耐受的独立危险因素(P＜0.05).结论 对重症胰腺炎患者采取早期肠内营养治疗可提升患者营养水平,改善肠黏膜屏障功能,但依然存在喂养不耐受情况发生.而年龄、腹内压、白蛋白、APACHE Ⅱ评分是早期肠内营养喂养不耐受的独立危险因素.
Abstract
Objective To explore the changes of intestinal mucosal barrier and risk factors of feeding intolerance before and after eraly en-teral nutrition treatment in patients with severe pancreatitis.Methods This study was a retrospective analysis of 80 patients with severe pancreati-tis admitted to the Huai'an Second People's Hospital from January 2020 to January 2023.All patients were treated with early enteral nutrition thera-py from 2 to 3 d after admission,and changes in the levels of prealbumin,albumin,endotoxin,diamine oxidase(DAO),and D-lactic acid were compared between pre-treatment and after 7 days of treatment.The occurrence of feeding intolerance during early enteral nutrition therapy was ob-served and recorded in 80 patients,who were divided into the feeding intolerance group(n=20)and the feeding tolerance group(n=60).And their age,gender,body mass index,hyperlipidemia,hypertension,diabetes mellitus,intra-abdominal pressure level,serum albumin level,central venous pressure(CVP)level were compared between the two groups.The occurrence of intestinal sounds,the acceptance of hemopurifica-tion,mechanical ventilation treatment,acute physiology and chronic health status evaluation Ⅱ(APACHE Ⅱ)score,and risk factors for feeding intolerance were analyzed using Multivariate Logistic regression analysis.Results After 7 days of treatment,the levels of prealbumin and albumin related nutritional indicators in patients with severe pancreatitis were(298.54±56.52)mg/L and(37.33±4.21)g/L,respectively,which were higher than those before treatment[(220.34±44.58)mg/L and(33.45±5.26)g/L],and the differences were statistically significant(P＜0.05).After 7 days of treatment,the levels of endotoxin,DAO,and D-lactate related intestinal mucosal barrier indicators in patients with severe pancreatitis were(0.44±0.13)EU/mL,(82.15±11.34)mg/mL,and(1.42±0.23)mmol/L,respectively,which were lower than before treatment[(0.96±0.16)EU/mL,(93.15±12.47)mg/mL,and(2.15±0.28)mmol/L],and the differences were statistically significant(P＜0.05).Univariate analysis showed significant differences in age,intra-abdominal pressure level,albumin level,CVP level,receipt of mechanical ventilation,and APACHE Ⅱ score between patients in the feeding-tolerant group compared with those in the feeding-intol-erant group(P＜0.05).Multivariate Logistic regression analysis showed that age,intra-abdominal pressure,albumin,and APACHE Ⅱ score were independent risk factors for feeding intolerance(P＜0.05).Conclusion Early enteral nutrition therapy for patients with severe pancreati-tis can enhance the nutritional level of patients and improve the intestinal mucosal barrier function,but feeding intolerance still exists.Age,intra-abdominal pressure,albumin,and APACHE Ⅱ score are independent risk factors for feeding intolerance in early enteral nutrition.
基金项目
江苏省重点实验室开放课题(XZSYSKF2021036)
NETL
NSTL
维普
万方数据