Clinical Study Of Enteral Versus Parenteral Nutrition Support In Severe Acute Pancreatitis

Background Severe acute pancreatitis(SAP)is a acute severe wasting disease of all over the body. The high metabolization and it's protein consumption caused by acute inflammation,negative nitrogen balance,and restrain of diet can always lead to severe dystrophy of patient,which caused a high mortality rate. So patients with SAP often suffered urgency episode and high mortality. Since 20'90th, the non-operative method of SAP was mainly regular measured.Utilization of nutritional support therapy,help decrease the the high incidence rate of complication, and control the high mortality. Since then,Parenteral nutrition (PN) was apply as one of main treatment of nutritional support therapy ,and has been widely utilized in the therapy of SAP. Large number of practice has provide that PN can boost in exogenous nitrogen,which help elevate the nutritional state of body,and avoid the stimulation in pancreas secretory action. But the following research discovered that, the long-term application of PN can lead to the atrophy of intestine mucous membrane,the breakdown of intestine mucous membrane barrier, translocation of enteric bacterium, which promote the infection happened in abdominal cavity and SAP pancreas. Meanwhile,the utilization of PN not only lead to the unavoidable complication caused by puncture and the septicemia caused by place canal, the family and society burden of costly medical fee which caused by long-time PN treatment can not be underestimate as well. Therefore,use an economical and effective approach (Enteral nutrition,EN) to replace PN has won widely recognition of research. Recent study indicated that ,EN's advantage can be list as follows:(1) consistent with physiology climate,promote intestinal mucosa barrier function,decrease enteric bacterium translocation;(2)help produce intestinal tract immunoglobulin,elevate organism immunity;(3)provide quantity sufficient glutamine;which can not provide by PN while have an important influence over organism immunity;(4)apparently promote nutritional state as well as PN;(5)clinic operation convenient,safety,little complication ;( 6 ) decrease the charge. Although peritonitis and enteroplegia can happen in the early state of SAP,while the complication can rapidly lessen or subsiding after the acute inflammation has been controled,which offer condition for the Utilization of EN. The enteral nutritional support of SAP is achieved by the naso-jejunum method or by inserting a catheter to the distal end of the ligament of Treitz through a jejunum fistula. Although the elementary animal experiment research and clinic application have been reported since some time ago in the West,it is only budding in domestic. The opportunity of perform EN in SAP patient,the effect of EN ,the advantage of EN when doing contrast research with PN,and the curative effect and security of EN are still unclear. Therfore,the research to evaluate the advantage and disadvantage of EN by doing random contrast research over PN ,measure the promotion of nutritional stated and organism immunity ; reduction of enteric bacterium translocation,complication rate and mortality.By judge the opportunity of perform EN,the EN status during SAP threapy,the research try to provide theorics evidence and clinic research material to the promoted and application of EN.Objectives To comparing enteral nutrition(EN) and parenteral nutrition(PN)in the teeatment of severe acute pancreatitis(SAP), in order to elucidate the feasibility and advantage of EN.Method 65 patients were randomly divided into PN and EN grouup. The nutritional status and the immunologic index were determined the 1st,7th and 14th day after giving the nutrition support,and the incidence of the complication,infection rate,mortality rate,hospital stay day and hospital expenditure were compared.Result After giving the nutrition support,the serum contents of albumin and transferring were increased obviously,and biood glucose and blood diastase were lowered significantly in both PN and EN groups(P<0.05).In EN group, complication,infection rate,mortality rate,hospital stay day and hospital fees were significantly lowercompared with PN group(P<0.05). In EN group, no obvious change was found on the serum IgA level, while in PN group the IgA level lowered from the beginning.Conclusion: It is safe and effective to give early EN support to patients with no contraindication. It was shown that the nutritional status of the patients was markedly improved, complication were reduced, infection rate and mortality rate were lowered, hospital stay days were shortened and expenditure in the hospital was cut down after EN support.