关键词: 重症急性胰腺炎, 早期肠内营养, 大黄, 全肠外营养

Abstract: AIM: To research the effects of rhubarb combining with early enteral nutrition on severe acute pancreatitis(SAP).METHODS: 64 patients with SAP were randomly received one of the three therapies below: 20 patients were treated with total parenteral nutrition(TPN), 23 patients were treated with early enteral nutrition(EEN), and 21 patients were treated with rhubarb combining with early enteral nutrition(REN). The hospitalization cost, length of stay, mortality, recovery time of intestinal function and score of APACHEⅡgrade were observed. The positive rate of plasma procalcitonin(PCT), the levels of C-reactive protein(CRP), pre-albumin, the percentage of CD₃,CD₄,CD₈,CD₄/CD₈ ratio and IgG, IgA, IgM were detected and compared.RESULTS: There was no patient died in REN group, but 1 in EEN group and 2 in TPN group.The recovery time of intestinal function in REN group was (2.6±0.7) days, the length of stay was (24±4) days ,the hospitalization cost was (5.5±0.7) thousands yuan, which were obviously shorter than those in the other groups(TPN group,P<0.01;EEN group,P<0.05). After two-week therapy, the score of APACHEⅡgrade in REN group was decreased from 11.8±2.4 to 3.1±1.0(P<0.01),which was lower than that in the TPN and EEN group(TPN group, P<0.01;EEN group, P<0.05).In addition,the level of CRP and the positive rate of PCT in REN group was respectively decreased(P<0.01),which were both lower than those in the other groups( EEN group,P<0.05; TPN group,P<0.01).The level of plasma pre-albumin in REN after two-week therapy was higher than before[(315±21) mg/L vs (121±9) mg/L,P<0.01],which was also higher than that in TPN group(P<0.01). After two-week treatment in REN group, the percentages of CD₃, CD₄ and CD₄/CD₈,IgG,IgA,IgM were increased, while the percentage of CD₈ was decreased, which were all of significant differences with those in EEN and TPN group(TPN,P<0.01;EEN,P<0.05).Besides,CD₄/CD₈ after two-week treatment in REN group was significantly higher than that in EEN and TPN group(TPN,P<0.01;EEN,P<0.05).CONCLUSION: REN is effective for severe acute pancreatitis. It is worthy of recommend because it can promote the recovery of the intestinal function, improve patients' nutritional and immune status, decrease the inflammatory reaction, shorten the length of stay and decrease the hospitalization cost. It is better than TPN and EEN therapy for SAP.

Key words: Severe acute pancreatitis, Early enteral nutrition, Rhubarb, Total parenteral nutrition  ,  ,  ,  ,