Clinical Study Of Early Low-dose Enteral Nutrition In The Treatment Of Severe Acute Pancreatitis

Objective:Severe acute pancreatitis(SAP)accounts for about 5%~10% of acute pancreatitis.Sap is a common critical disease of digestive system.It has a rapid progress,a variety of clinical outcomes and a mortality rate of 30%.It is necessary to consider the functional state of organs and the metabolism and utilization of nutrients in patients with severe acute pancreatitis when they are given enteral nutrition.Early enteral nutrition should avoid overfeeding,a large number of nutritional support may increase the burden of metabolism,aggravate metabolic disorders and organ function damage.The purpose of this study is to explore the effect of early low-dose enteral nutrition on the clinical efficacy and prognosis of severe acute pancreatitis.Methods:The clinical data of 58 patients with severe acute pancreatitis admitted to the First Hospital of Shanxi Medical University from October 2017 to March 2019 were selected as the study objects by retrospective study.58 patients with severe acute pancreatitis were divided into two groups: early low-dose enteral nutrition group(25 cases)and delayed enteral nutrition group(33 cases).Patients in both groups were given diet prohibition,gastrointestinal decompression,anti infection,correction of electrolyte disorder,acid suppression,inhibition of pancreatic secretion,and appropriate parenteral nutrition.Early enteral nutrition group(low-dose Group): within 24-48 hours after admission,when the liquid is fully resuscitated and the hemodynamics is stable,nasojejunostomy tube is retained to open enteral nutrition.At first,the enteral nutrition agent SP 10-20 kcal/h was injected into the intestine at a constant speed.After the intestinal function recovered,the enteral nutrition pump speed was increased by 10 ml/h every 24 hours according to the feeding tolerance.Delayed enteral nutrition group(control group): after 48 hours of admission,the patients will start enteral nutrition when the intestinal function is fully restored.The initial dose is 10-20 kcal/h.according to the patient’s tolerance,the pump speed of enteral nutrition will be increased by 10 ml/h every24 hours,and gradually until the target dose is reached.Results:Fifty-eight patients with severe acute pancreatitis were included in the analysis,including 30 males and 28 females,aged from 20 to 82 years,with an average age of(45.1±16.5)years.Relevant causes of severe acute pancreatitis were biliary in 27 cases,hyperlipidemia in 23 cases,and alcoholic in 8 cases.There were no significant differences in gender,age,APACHE II score and etiology between the two groups(P>0.05),and the baseline data were comparable.Twenty-five patients with early low-dose enteral nutrition(low-dose group): 12 males and 13 females,age(35.7±9.4)years,APACHE II score(20.8±2.1).There were 33 patients in delayed enteral nutrition group(control group): 18 males and 15 females,age(49.5±17.4)years,APACHE II score(21.5±2.3).There was no significant difference in serum albumin(ALB)and total protein(TP)levels between the two groups on the first day of admission and on the 14 th day of treatment(all P>0.05).The incidence of feeding intolerance in the early low-dose enteral nutrition group(low-dose group)was significantly lower than that in the delayed enteral nutrition group(control group),and the difference was statistically significant(P<0.05).The recovery time of intestinal function in the early low-dose enteral nutrition group(low-dose group)was faster than that in the delayed enteral nutrition group(control group),and the difference was statistically significant(P<0.05).The incidence of infection-related complications in the early low-dose enteral nutrition group(low-dose group)was lower than that in the delayed enteral nutrition group(control group),and the difference was statistically significant(P<0.05).There was no significant difference in pancreatic pseudocysts between the two groups(P>0.05).There were no significant differences in AMY and LPS recovery time and total hospitalization time between the two groups(all P>0.05).Conclusion:Studies have shown that early low-dose enteral nutrition is safe and effective in the treatment of severe acute pancreatitis.Early low-dose enteral nutrition is conducive to the recovery of intestinal function in SAP patients,reduces the incidence of feeding intolerance and infection-related complications,and improves the prognosis of patients.Early low-dose enteral nutrition is the further refinement and perfection of acute pancreatitis based on the nutritional concept.In this study,the concept of early low-dose enteral nutrition in the treatment of severe acute pancreatitis was put into practice,providing a reference program for the nutritional treatment of severe acute pancreatitis.