Effect Of Oral Enteral Nutrition On Patients With Moderately Severe Acute Pancreatitis

Purpose:Nutritional support therapy is very important in the diagnosis and treatment of acute pancreatitis(AP),and enteral nutrition(EN)is the first choice in nutritional therapy.It can maintain the intestinal barrier and prevent bacterial translocation,mainly through the naso jejunal tube.At present,the best way of enteral nutrition in moderate severe acute pancreatitis(MSAP)is not clear.This study intends to compare the effects of oral enteral nutrition and nasojejejunal nutrition(NJ)in the treatment of moderate severe acute pancreatitis,so as to clarify the effect of oral enteral nutrition on patients with moderate severe acute pancreatitis.Methods: The clinical data of 400 patients with moderate severe acute pancreatitis treated in the First Affiliated Hospital of Nanchang University from January 2019 to March 2021 were analyzed retrospectively.Then,after 400 patients with acute moderate severe pancreatitis were matched with propensity score(PS),82 patients with oral diet were matched with 82 patients with nasojejunal tube 1:1.The nutritional status and medical resource occupation of patients after enteral nutrition treatment were taken as the primary endpoint.The additional outcomes included disease severity,secondary infection and enteral nutrition tolerance.The primary and secondary outcome variables of the two groups were compared and analyzed.Multivariate logistic regression and multiple linear regression were used to analyze the relationship between enteral nutrition pathway and clinical results.Results:All hospitalized patients from January 2019 to March 2021 were screened by the case collection system of the First Affiliated Hospital of Nanchang University,3073 patients were retrieved,and 400 patients remained after the screening of natriuretic exclusion criteria.According to the different routes of enteral nutrition,the patients were divided into oral enteral nutrition group and nasojejunal nutrition group,221 cases and 179 cases respectively.Then all patients were analyzed by Propensity Score Matching.Finally,164 patients were included in the study,including 82 patients in the oral enteral nutrition group and 82 patients in the nasojejunal group.There were no significant differences in gender,age,etiology,nutrition start time(The starting time of enteral nutrition is calculated from admission),nutrition duration,Procalcitonin(PCT),C-reactive protein(CRP),and whether albumin was infused during enteral nutrition,disease severity score(APAECH-Ⅱ score,MCTSI score,BISAP score,Ransnon score and SIRS score)before enteral nutrition.There was no significant difference in hemoglobin difference,length of hospital stay and hospitalization expenses between oral enteral nutrition group and nasojejunal nutrition group before and after enteral nutrition(P > 0.05);Before and after enteral nutrition,the mean value of albumin difference in nasojejunal tube group(2.347 ± 6.186)was higher than that in import group(-1.857 ± 6.673),and the difference was statistically significant(P < 0.05).Multiple linear regression analysis showed that nutritional treatment through nasojunal tube was an independent protective factor of albumin;After nutritional support,there was no significant difference in the incidence of readmission,respiratory failure,renal failure,abnormal liver function,shock,electrolyte metabolism disorder,SIRS,infection and extrapancreatic infection(blood infection and abdominal infection)between the oral enteral nutrition group and the nasojejural group(P > 0.05).The incidence of pulmonary infection in the nasojejunual nutrition group(36.6%)was higher than that in the oral enteral nutrition group(13.4%),The difference was statistically significant(P < 0.05).Binary logistic regression showed that nasojejul nutrition support was an independent risk factor of pulmonary infection;In the analysis of enteral nutrition tolerance,there was no significant difference in the incidence of abdominal pain and abdominal distension between the two groups(P > 0.05).In the analysis of the incidence of diarrhea between the two groups,the difference was statistically significant(P < 0.05).Binary logistic regression showed that the type of enteral nutrition support was an independent risk factor of diarrhea.Conclusion:Oral enteral nutrition plays a certain role in the treatment of MSAP.In terms of tolerance,oral enteral nutrition seems to be better than nasal jejunal nutrition.Oral diet can reduce the incidence of diarrhea and pulmonary infection,while nasal jejunal enteral nutrition can better improve the nutritional status of patients.There is no significant difference in safety and efficacy.