中国临床药学杂志

目的 探讨早期肠内营养与低分子量肝素联合治疗重症急性胰腺炎（SAP）的临床疗效，并分析该治疗方案对病情控制、微循环障碍及并发症的影响。方法 选取2020年1月至2021年6月SAP患者98例，按照随机数字表法分为单一组和联合组，每组49例。2组均给予常规基础治疗，单一组采取早期肠内营养支持，联合组采取早期肠内营养支持联合低分子量肝素。比较2组临床疗效、康复进程、治疗前后病情控制情况[急性生理与慢性健康评价系统Ⅱ（APACHEⅡ）、CT严重程度指数（CTSI）评分]，微循环障碍指标[胰腺血流量（BF）、血流容积（BV）、灌注达峰时间（TTP）]，炎性因子[血清C反应蛋白（CRP）、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]水平及并发症情况。结果 联合组临床治疗总有效率高于单一组（P <0.05）；联合组腹痛缓解、腹胀缓解、肠鸣音恢复、血清淀粉酶恢复时间和住院天数短于单一组（P <0.05）；治疗1周后2组APACHEⅡ、CTSI评分低于治疗前，联合组低于单一组（P <0.05）；治疗1周后2组胰脏BF、BV高于治疗前，联合组高于单一组，TTP短于治疗前，联合组短于单一组（P <0.05）;2组治疗1周后血清CRP、IL-6、TNF-α水平低于治疗前，联合组低于单一组（P <0.05）；联合组并发症发生率低于单一组（P <0.05）。结论 早期肠内营养与低分子肝素联合治疗SAP能显著提高疗效，加快病情控制，缩短康复进程，改善胰腺微循环障碍，减轻炎症反应，还可降低并发症风险。

AIM To investigate the clinical efficacy of early enteral nutrition combined with low molecular weight heparin in the treatment of severe acute pancreatitis(SAP), and to analyze the effect of this treatment scheme on disease control, microcirculation disturbance and complications. METHODS A total of 98 SAP patients from January 2020to June 2021 were selected according to the random number table method, with 49 patients in each group. Both groups were given routine basic treatment, the monotherapy group was given early enteral nutrition support, and the combined group was given early enteral nutrition support combined with low molecular weight heparin. The clinical efficacy,rehabilitation process, disease control before and after treatment [acute physiology and chronic health evaluation system Ⅱ(APACHE Ⅱ) score, CT severity index(CTSI) score], microcirculation disturbance indicators [pancreatic blood flow(BF), blood flow volume(BV), time to peak perfusion(TTP) ], inflammatory factors [serum C-reactive protein(CRP), tumor necrosis factor-α(TNF-α), interleukin-6(IL-6) ] levels and complication rates were compared.RESULTS The total effective rate of clinical treatment in the combined group was higher than that in the monotherapy group(P<0.05); the abdominal pain relief, abdominal distension relief, bowel sounds recovery, serum amylase recovery time, and hospitalization time in the combined group were shorter than those in the monotherapy group(P < 0.05). After 1week of treatment, the APACHE Ⅱ and CTSI scores of 2 groups were lower than those before treatment, and the combined group were lower than the monotherapy group(P < 0.05). After 1 week of treatment, the BF and BV of the pancreas in 2groups were higher than those before treatment, the combined group were higher than the monotherapy group; the TTP was shorter than that before treatment, and the combined group was shorter than the monotherapy group(P < 0.05); the serum CRP, IL-6 and TNF-α levels in 2 groups after 1 week of treatment were lower than those before treatment, and the combined group were lower than the monotherapy group(P < 0.05); the incidence of complications in the combined group was lower than that in the monotherapy group(P < 0.05). CONCLUSION Early enteral nutrition combined with low molecular weight heparin in the treatment of SAP can significantly improve the curative effect, speed up the disease control, shorten the rehabilitation process, improve the pancreatic microcirculation disorder, reduce the inflammatory response, and reduce the risk of complications.