| Objective: To observe the different condition,inflammation makers,toleration and prognosis by three lumen nasojejunal tube and nasogastric tube enteral nutrition(EN)in patients with severe acute pancreatitis,thus evaluating clinical effect of early three lumen nasojejunal tube enteral nutrition in treating patients with severe acute pancreatitis.Methods: All the 68 subjects were selected from patients admitted to Affiliated Hospital of Jining Medical University emergency Intensive Care Unit from January2015 to December 2016 with severe acute pancreatitis according to China’s guidelines of diagnosis and treatment of acute pancreatitis,2003,ShangHai.All the 68 subjects were divided into the three lumen nasojejunal tube group(Observational group,36cases)and the nasogastric tube group(Control group,32 cases)according to the random number table method.Observational group were given three lumen nasojejunal tube enteral nutrition while control group were given nasogastric tube enteral nutrition in hospital when the patents were in a stable circulation and intestinal tract function.Curative effect evaluation index: Record the clinical data of all patients,collecte the laboratory indexes such as blood biochemistry and blood routine during admission,and calculate the APACHEII scores and MCTSI scores.The APACHEII score was re-evaluated on the 1st,3rd,5th,7th and 14 th days of treatment.Record the EN start time and achieved full-amount time.Record the starting time of EN and the time of total nutrition EN.Record the determination of PA on admission and 7th day after teatment.Record the determination of C reactive protein(CRP)on admission and 1st day,3rd day,7th day after teatment.Record the determination of tumor necrosis factor-α(TNF-α)and interlenkins-6(IL-6)on admission and 7th day after teatment.Record the time of abdominal pain/distention,observe and record gastric retention,regurgitation,diarrhoea,abdominal pain and worsen during EN treatment.Finally summary the total effective rate,mortality rate,and ICU stay time.The two groups for statistical analysis were performed with software application SPSS 20.0,P<0.05 was considered significant.Results:1 Comparison of general data: The differences of gender composition,age,disease time before admission and pathogenesis between had no statistical significance(P>0.05).Comparison of patient’s condition: The APACHEⅡ score of observational group were 9.22±3.48 while The APACHEⅡ score of control group were 9.25±3.11,the indexes had no statistical significance(P>0.05).The MCTSI score of observational group were 4.56±1.48 while The APACHEⅡ score of control group were 4.69±1.49,The differences of the indexes had no statistical significance(P>0.05).2 The starting time of EN of observational group were 2.56±1.23 days while the starting time of EN of control group were 3.59±1.27 days,the differences of the indexes had significant statistical significance(P=0.001)using t-test.The time of EN for total nutrition of observational group were 7.36±2.70 days while time of EN for total nutrition of control group were 8.78±2.86 days,the differences of the indexes had statistical significance(P<0.05).3 Comparison of changes of APACHEⅡ score: The APACHEⅡ score of observational group were 6.17±3.26 while the APACHEⅡ score of control group were7.53±4.47 on 1st day.The APACHEⅡ score of observational group were 3.53±1.7while the APACHEⅡ score of control group were 5.9±4.09 on 3rd day.The APACHEⅡ score of observational group were 2.25±1.7 while the APACHEⅡ score of control group were 4.31±3.29 on 5th day.The APACHEⅡ score of observational group were 2.14±2.51 while the APACHEⅡ score of control group were 2.47±2.92 on7 th day.The APACHEⅡ score of observational group were 1.53±3.46 while the APACHEⅡ score of control group were 1.53±2.9 on 14 th day.Intra-group comparison before the 7th day had statistical significance(P<0.05).Comparison between the two groups had statistical significance(P<0.05)on 3rd day and 5th day.4 Comparison of changes of inflammation markers: The determination of CRP of observational group was 127.6±74.3mg/L while the determination of CRP of control group was 131.2±82.2mg/L on admission.The determination of CRP of observational group were 116.7±74.49mg/L,68.8±55.1mg/L,31.5±29.7mg/L on 1st day,3rd day,7th day while the determination of CRP of control group were127.9±82.1mg/L,75.2±60.4mg/L,35.3±31.4mg/L on 1st day,3rd day,7th day.The determination of CRP of the two groups were decline.Intra-group comparison had statistical significance(P<0.05)while comparison between the two groups had no statistical significance(P>0.05).The determination of TNF-α of observational group were 37.16±8.07pg/ml on admission,25.32±7.27pg/ml on 7th day while the determination of TNF-α of control group were 37.28 ± 7.78pg/ml on admission,27.36±7.27pg/ml on 7th day.The determination of IL-6 of observational group was1.81±12.32pg/ml on admission,25.32±7.27pg/ml on 7th day while the determination of IL-6 of control group was 57.72±12.79pg/ml on admission,27.36±7.27pg/ml on7 th day.Intra-group comparison of the changes of determination of CRP and IL-6after treatment of the two groups had statistical significance(P<0.05)while comparison between the two groups had no statistical significance(P>0.05).5 Comparison of changes of nutrition assessment: The determination of PA of observational group was 128.5±31.1g/L on admission,189.1±23.9g/L on 7th day while the determination of IL-6 of control group was 134.4±38.3g/L on admission,174.58±27.7g/L on 7th day.Intra-group comparison of the changes of determination of PA after treatment of the two groups were increasing,had statistical significance(P<0.05)while comparison between the two groups had no statistical significance(P>0.05).Intra-group comparison of the changes of determination of PA of observational group had statistical significance(P<0.05).6 Comparison of changes of the time of abdominal pain relief and bloating relief:The time of abdominal pain relief and bloating relief of observational group were55.22±18.93 hours while the control group were 73.88±23.43 hours,the comparison between the two groups had statistical significance(P<0.05).The comparison of complication between the two groups had statistical significance(P<0.05).The comparison of occurrence rate of stomach stores and gastric reflux between the two groups had statistical significance when one subject in observational group and seven subjects in control group(P<0.05).Comparison of occurrence rate of diarrhoea and abdominal pain exacerbation between the two groups had no statistical significance(P>0.05).7 Comparison of changes of the effective rate: The effective rate of observationalgroup were 80.55% while the effective rate of control group were 78.12%,comparison between the two groups had no statistical significance(P>0.05).Comparison of the mortality rate of the two groups had no statistical significance when one subject in observational group and two subjects in control group(P>0.05).The ICU time of observational group were 8.56±3.47 days while ICU time of control group were 10.5±3.93 days had statistical significance(P<0.05).Conclusion:1 The using of EN by three lumen nasojejunal tube can relieve clinical symptoms and ICU time in patients with SAP.2 Three lumen nasojejunal tube is safer than nasogastric tube in EN which had a lower occurrence rate of stomach stores and gastric reflux and clinical value to be spread.3 The using of EN by three lumen nasojejunal tube and nasogastric tube had similar therapeutic efficacy in patients with SAP. |
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