对比分析肠内免疫微生态营养、免疫增强型肠内营养对重症急性胰腺炎（SAP）疗效、大便菌群变化情况、预后与营养状态的影响。

选择2015年6月至2016年12月宣化县人民医院收治的SAP患者96例，随机分为EE组（给予肠内免疫微生态营养）和IE组（给予免疫增强型肠内营养），每组48例，并选择同期单纯因严重腹胀无法进行早期肠内营养支持的SAP患者24例，设为对照组。对比三组患者干预前以及干预后1周、2周时疗效指标（血清白蛋白、淀粉酶AMS、白细胞计数）、营养状况指标（前白蛋白PAB、转铁蛋白TRF）、发病7~10 d后大便菌群变化情况（菌群失调发生率），2周后观察并分析各组肠内营养治疗中不良反应、并发症发生情况。

(1)干预治疗后第1、2周组内对比三组血清白蛋白、淀粉酶、白细胞水平低于干预前，EE组白细胞计数、AMS恢复时间低于IE组，两组低于对照组，其中第1周时EE、IE组白蛋白水平低于对照组，差异有统计学意义（P<0.05）。(2)EE、IE组干预后1~2周的前白蛋白水平均高于对照组，但两组差异无统计学意义；EE、IE组干预后1~2周的TRF差异无统计学意义，干预后1周时的TRF均高于对照组（P<0.05）。(3)干预7~10 d后，EE组大便菌群涂片检查菌群失调发生率低于IE组和对照组，差异有统计学意义（χ²=5.315、5.679，P=0.021、0.017）。(4)EE、IE组各类并发症发生率、严重并发症总发生率差异无统计学意义，其中严重并发症合计发生率均低于对照组（χ²=12.255、10.867，P=0.000、0.001），三组均未见死亡与不良反应。

对SAP患者建议早期实施合理的肠内营养治疗，特别是肠内免疫微生态营养治疗，有助于改善肠道微生态环境，降低并发症发生风险。

To compare the effects of enteral immune, enteral ecoimmunonutrition (EE), immune enhanced enteral nutrition (IE) on the efficacy, stool flora, prognosis and nutritional status in patients with severe acute pancreatitis (SAP).

From June 2015 to December 2016, ninety six patients with SAP were randomly divided into EE group and IE group, with 48 cases in each group. Meanwhile, 24 patients with SAP who were unable to undergo early enteral nutrition support due to severe abdominal distension during the same period were selected as control group. Comparison indexes of the three groups before and after intervention for 1 week and 2 weeks included efficacy indicators (serum albumin, amylase, white blood cell count), nutritional status index (albumin, transferrin) and the pathogenesis of 7-10 d after the fecal flora changes (dysbacteriosis incidence). After 2 weeks, side reactions, complications and adverse prognosis were observed and analyzed.

(1) 1 week and 2 weeks after intervention, serum albumin, amylase, WBC level of the three groups were lower than that before the intervention. White blood cell count, AMS recovery time in EE group were lower than those in the IE group, the two groups both lower than that in the control group. At the first week, the levels of albumin in EE and IE groups were lower than those in the control group, the difference was statistically significant (P<0.05). (2) The levels of prealbumin in EE and IE groups were higher than those in the control group at 1-2 weeks after intervention, but there was no significant difference between the two groups. There was no significant difference in TRF between EE and IE group at 1-2 weeks after intervention, and the TRF at the first week was higher than that in the control group (P<0.05). (3) 7-10 days after the intervention, the incidence of bacterial flora in stool smear of EE group was lower than that in IE group and control group, the difference was statistically significant (χ²=5.315, 5.679, P=0.021, 0.017). (4) The incidence of complications and the total incidence of severe complications in EE and IE group were not statistically significant, and the total incidence of serious complications was lower than that of the control group (χ²=12.255, 10.867, P=0.000, 0.001), and no deaths or adverse reactions occurred in the three groups.

For patients with SAP, it is suggested that early enteral nutrition therapy, especially enteral immune micronutrition therapy, can help improve the microenvironment of the intestinal tract and reduce the risk of complications.