急診十二指腸鏡聯合早期腸內營養治療老年急性膽源性胰腺炎ABP效果及并發癥分析

[摘要] 目的 分析急性膽源性胰腺炎老年患者接受急診十二指腸鏡、早期腸內營養聯合醫治效果及其并發癥影響。方法 整群選取2014年2月—2016年5月于該院醫治的104例老年ABP患者臨床資料，按醫治方式不同分為兩組，每組52例，單行急診十二指腸鏡醫治對照組，在其基礎上聯合早期腸內營養治療觀察組，對比兩組醫治效果與并發癥情況。結果 觀察組醫治后發熱、腹痛、后背脹痛等癥狀改善時長均比對照組短，差異有統計學意義（P<0.05）；觀察組治療后血AMY、WBC、TBIL、PLT、CRP、TNF-α水平均比對照組優，差異有統計學意義（P<0.05）；觀察組治療后并發癥總發生率7.69%比對照組23.08%低，差異有統計學意義（P<0.05）。結論 老年急性膽源性胰腺炎患者經急診十二指腸鏡、早期腸內營養聯合治療后，可有效改善臨床癥狀，調衡患者機體環境，減低并發癥風險，是安全、有效的醫治方案。

[關鍵詞] 急診；十二指腸鏡；腸內營養；急性膽源性胰腺炎

[中圖分類號] R5 [文獻標識碼] A [文章編號] 1674-0742（2016）12（c）-0050-03

[Abstract] Objective To analyze the effect of acute duodenoscopy combined with early enteral nutrition and its complication in senile patients with acute biliary pancreatitis.Methods Group selection the clinical data of 104 elderly patients with ABP treated in our hospital from February 2014 to May 2016，which divided into two groups according to different treatment.52 patients each group，the control group was treated with emergency duodenoscopy，the study group combined early enteral nutrition therapy based on the control group， compared the treatment and complications of two groups.Results After treatment， the symptoms of fever， abdominal pain and back pain in the study group were shorter than those in the control group，the diffemence was statistically significant（P<0.05）.The levels of blood AMY，WBC，TBIL，PLT，CRP and TNF-α in the study group were superior to those in the control group，the diffemence was statistically significant（P<0.05）. The overall incidence of complications in the study group（7.69%） was lower than that in the control group（23.08%），the diffemence was statistically significant（P<0.05）. Conclusion Combined treatment of acute duodenoscopy and early enteral nutrition could improve the clinical symptoms， adjust the environment of patients and reduce the risk of complications. It was a safe and effective treatment plan for acute biliary pancreatitis in elderly patients.

[Key words] Emergency； Duodenoscopy； Enteral nutrition； Acute biliary pancreatitis

急性膽源性胰腺炎（ABP）屬臨床多發病，病情發展迅速，致死率高，患者在患有ABP后，腸道功能被破壞，細菌、毒素入侵腸道內穿透腸黏膜滲入血液中，引起致命性并發癥，故臨床醫治ABP時應重點保護腸黏膜屏障功能，以提高患者預后[1]。以往臨床常采取十二指腸鏡醫治ABP，可降低重癥胰腺炎發病率，尤其是治療合并內科基礎病的老年患者療效佳。鑒于ABP老年患者機體呈分解、代謝均較高狀態，且機體功能減退，故而機體內環境紊亂嚴重，身體營養嚴重不足[2]。因此，該院認為老年ABP患者應及早接受腸內營養治療，以維持機體營養均衡，增強免疫力，以支持后期治療。……