重症急性胰腺炎患者肠内营养启动成功的独立预测因素

赵永生; 李欣欣; 寇佳琪; 孔令雪; 赵庆华; 任为正; 何蕾

doi:10.3969/j.issn.2095-5227.2021.06.005

重症急性胰腺炎患者肠内营养启动成功的独立预测因素

Factors associated with success initiation of enteral nutrition in severe acute pancreatitis

摘要

摘要:
背景近年来研究表明早期肠内营养可以改善重症急性胰腺炎患者预后；但对于存在禁忌证的患者，早期启动肠内营养可能难以耐受。
目的研究影响重症急性胰腺炎患者肠内营养成功启动的影响因素，探讨重症急性胰腺炎肠内营养治疗的合理使用。
方法回顾性分析2019年1 - 12月解放军总医院第一医学中心肝胆胰外科医学部收治的应用肠内营养的重症急性胰腺炎患者。收集重症急性胰腺炎患者肠内营养时间、72 h后耐受情况、肠内营养的疗效，比较成功组与失败组的条件差异。
结果纳入SAP患者35例，应用肠内营养共109例次，营养途径包括口服和管饲，肠内营养种类包括单糖以上的食物或营养制剂。其中男性65例次(59.63%)，女性44例次(40.37%)，中位年龄46岁(IQR：36，62)。肠内营养成功率71.6%(78/109)。Logistic回归结果显示体温＞37.3℃(OR=0.07，95% CI：0.01～0.27，P＜0.001)与肠内营养成功与否独立关联。
结论体温升高患者启动肠内营养易发生不耐受和启动失败。

Abstract:
Background Recent studies have showed that early enteral nutrition(EN) was associated with improved prognosis, but for those with contradictions, it might not be tolerated.
Objective To study the timing of enteral nutrition and explore the rational use of enteral nutrition for patients with severe acute pancreatitis.
Methods Data of SAP patients admitted to the Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, and received enteral nutrition from January to December in 2019 were retrospectively collected and analyzed. The time of initiation of enteral nutrition, the tolerance after 72 hours and the effect of enteral nutrition in patients with SAP were collected, and the differences were compared between the success group and the failure group.
Results From January to December in 2019, 35 patients with SAP were enrolled, receiving 109 times of EN. Methods of feeding included oral and tube feeding, and the fomula covering multiple supplements such as monosaccharide, normal diet, etc. Among the 109 times of EN, 65 (59.63%) times were for male, 44 times were for female (40.37%), and their median age was 46 years (IQR: 36, 62). The success rate of EN was 71.6% (78/109). Multivariate logistic regression analysis showed body temperature＞37.3℃(OR=0.07, 95% CI: 0.01, 0.27, P＜0.001) were independent risk factor associated with the success of EN.
Conclusion Elevated body temperature was independent risk factors for diet intolerance.

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