探讨肠功能恢复状态对判断急性胰腺炎患者肠内营养支持治疗时机的临床应用价值。

收集2017年3月至2019年2月诊断为急性胰腺炎且入院时采取禁食治疗的患者156例，试验组84例，对照组72例，试验组通过肠功能恢复状态判断肠内营养治疗时机，对照组根据主诊医师各自临床经验决定肠内营养时机，采用t检验对比2组患者肠内营养开放时间、多项实验室指标［淀粉酶（AMY）、C-反应蛋白（CRP）、白细胞（WBC）］、急性胰腺炎严重程度床边指数（BISAP评分）、住院时间、住院费用、满意度等指标的差异，采用χ²检验比较不良事件［包括进食不耐受，恶心和（或）呕吐以及复发性腹痛］发生情况，以评估肠功能恢复状态判断肠内营养时机的临床应用价值。

试验组急性胰腺炎患者禁食后肠内营养开放时间少于对照组［（32.58±14.15）h vs （70.04±30.23）h］，差异具有统计学意义（t=-9.65，P<0.01）；试验组经治疗后复查CRP、BISAP 7低于对照组［（36.52±26.47）mg/L vs （49.90±24.04）mg/L，（0.44±0.61）分 vs （0.90±0.86）分］，差异具有统计学意义（t=-3.27、-3.82，P=0.001、<0.001），AMY、WBC的组间比较，差异均无统计学意义（P均>0.05）；试验组较对照组住院时间有效缩短［（10.35±2.42）d vs （11.21±2.69）d］，患者满意度评分得到提高［（91.71±5.81）分vs（88.94±7.09）分］，差异均具有统计学意义（t=-2.11、2.64，P=0.037、0.009）；但2组之间不良事件发生率比较，差异均无统计学意义（P均>0.05）。

通过肠功能恢复状态作为判断依据决定肠内营养开放时机，与根据医师临床经验相比，有效缩短了急性胰腺炎患者肠内营养开放时间，有利于BISAP评分、CRP的下降，缩短了患者住院时间、提高了住院满意度，且未增加不良事件发生率。

To investigate the clinical value of intestinal function recovery status in judging the timing of enteral nutrition support in patients with acute pancreatitis.

A total of 156 patients who were diagnosed with acute pancreatitis from March 2017 to February 2019 and underwent fasting treatment at admission were enrolled, including 84 patients assigned to an study group and 72 patients assigned to a control group. In the study group, the timing of enteral nutrition treatment was judged based on the recovery of intestinal function. In the control group, the timing of enteral nutrition was determined according to the clinical experience of the attending physician. The time to starting enteral nutrition, multiple laboratory indicators (amylase [AMY], C-reactive protein [CRP], and white blood cells [WBC]), acute pancreatitis severity bedside index (BISAP score), adverse events (including eating intolerance, nausea, and/or vomiting), hospitalization time, hospitalization expenses, and satisfaction were compared between the two groups by the t-test or χ² test to assess the clinical value of intestinal function recovery in judging the timing of enteral nutrition.

The time to starting enteral nutrition after fasting for patients with acute pancreatitis in the study group was significantly shorter than that in the control group [(32.58±14.15) h vs (70.04±30.23) h, t=-9.65, P<0.01]. CRP and BISAP scores after treatment were significantly lower in the study group than in the control group [(36.52±26.47) mg/L vs (49.90±24.04) mg/L, (0.44±0.61) vs (0.90±0.86), t=-3.27 and -3.82, P=0.001 and <0.001, respectively]. There was no significant difference in AMY and WBC between the two groups (P>0.05). The hospitalization time of the study group was significantly shorter than that of the control group [(10.35±2.42) d vs (11.21±2.69) d, t=-2.11, P=0.037], and the score of patient satisfaction was significantly higher in the study group than in the control group [(91.71±5.81) vs (88.94±7.09), t=2.64, P=0.009]. There was no significant difference in adverse events between the two groups (P>0.05).

Compared with judging the timing of enteral nutrition based on the clinician's clinical experience, the recovery of intestinal function in judging the timing of enteral nutrition in acute pancreatitis patients is beneficial in reducing BISAP score and CRP, shortening the hospitalization time, and improving patient satisfaction, without increasing the incidence of adverse events.