| Acute pancreatitis (AP) is one of the common surgical acute ventral syndromes, and 15%~20% of it is severe acute pancreatitis (SAP). SAP has complicated state of illness, dangerous clinical symptom, fast progress and many complications, its mortality rate is about 10% ~ 30%. SAP has higher mortality rate mostly due to pancreatic tissue putrescence after bacterial infection, which induced systemic inflammatory response syndrome and ultimately multiple organ dysfunction. Intestinal bacterial translocation is the main pathogen causing infection, and when SAP impaired intestinal mucosal barrier function and then increased permeability is the important reason induced the translocation of intestinal bacterial and endotoxin. In addition, in the early period of SAP protein catabolism, gluconeogenesis and enhanced fat mobilization make the body at a high state of catabolism and so the rapid consumption of nutritional reserves, this can lead to acute malnutrition, which is another important reason of the SAP patients'death. Early recovery of gastrointestinal function, that is, as soon as possible to stimulate the peristalsis of stomach, empty intestinal content, at the same time give the appropriate treatment of nutritional support can effectively protect the intestinal mucosal barrier, maintain and improve the nutritional status of patients with SAP and enhance the body's defense capabilities to reduce the occurrence of various complications and improve cure rate. Therefore, the early recovery of gastrointestinal function combining with the nutritional support is one of important comprehensive treatment measures of SAP, it has a important significance during the early treatment of SAP.The clinical data of admitted 44 cases with SAP were collected from March 2006 to December 2008 in our hospital and were retrospectively analyzed to explore the clinical value of the early recovery of gastrointestinal function combining with early enteral nutrition support in this paper .Methods: All cases were accord with the diagnostic criteria of "guidelines for diagnosis and treatment of severe acute pancreatitis" formulated by the Chinese Medical Association branch of the pancreas surgery group. All the cases were divided into two groups: the treatment group which treated by early recovery of gastrointestinal function combining with early enteral nutrition (EN) (21 cases); the control group which treated by total parenteral nutrition (TPN) during the whole course (23 cases). It was given routine treatment such as fasting water and food, gastrointestinal decompression, antiacid, inhibiting pancreatic enzyme, total parenteral nutrition, etc. in the control group. Treatment group was given the recovery of gastrointestinal function additionally based on the treatment of the control group (1, antiphlogistic soup of pancreas injection by gastric tube; 2, electro-acupuncture of bilateral Zusanli; 3, mirabilite overcoating), it was give enteral nutrition through nose jejunal feeding tube during the recovery of gastrointestinal function. By comparing the treatment results of both group, abdominal distension alleviating time, the bowel sound recovery time, recovery time of defecation and exhaust, the time of taking food by mouth were investigated; the body mass, serum albumin, pre-albumin, white blood cell count, serum amylase, urine amylase and serum calcium were determined at admission and the seventh and fourteenth after nutritional support respectively; the difference of the happening incidence of complications, secondary infection rate, mortality rate, the total length of stay and treatment cost were compared.Result: Abdominal distension alleviating time, the bowel sound recovery time, recovery time of defecation and exhaust, the time of taking food by mouth of the treatment group were significantly earlier than the control group's, there was a statistical significance; albumin and prealbumin of the treatment group were significantly higher than those in control group, the ability of decreasing serum white blood cell count of the treatment group was better than the control group with a statistical significance; bacteria and fungi infection rate were significantly lower and the duration of hospitalization and treatment cost of the treatment group were significantly less than the control group with statistical significance ; the happening incidence of complications and mortality of the treatment group were also lower than the control group, but without statistical significance.pancreatic tissue damage and necrosis were happened in the several hours after the onset of SAP, large amounts of toxic liquid seeping blood, local microcirculation barrier and local inflammatory response lead to gastrointestinal edema, smooth muscle peristalsis disappear, the accumulation of a large number of digestive juice in the cavity, because a long time paralysis of the intestine and the increasing of the permeability of intestinal mucosa induced intestinal epithelial barrier dysfunction, translocation of intestinal flora and the producing of endotoxin. After the endotoxin went into the systemic circulation, the systemic inflammatory response syndrome can be triggered, it can result in a two-hit to the pancreas and other organs. Abdominal distension alleviating time, the bowel sound recovery time, recovery time of defecation and exhaust, the time of taking food by mouth of the treatment group were significantly earlier than the control group's, there was a statistical significance after the treatment by anti-inflammatory soup injecting into the pancreas by gastric tube, bilateral electroacupuncture Zusanli and mirabilite overcoating to recover the gastrointestinal function, this indicated the recovery of triple gastrointestinal function that used in this study had a better curative effect to promote the restoration of gastrointestinal function from the nerves, fluids, etc., when the happening of SAP, as a result of circulatory disturbance and ischemia-reperfusion injury, a large number of cell factor and inflammatory mediator released; a large number of toxic residues existed for gastrointestinal motility barrier and intestinal bacterium group disorder; the lack of enteral nutrition and other factors lead to intestinal barrier dysfunction. In our research, the treatment group was given the recovery of three way gastrointestinal function when admission, entire or part of the gastrointestinal function recovered after 48-72 hour from admission. that was the restoration of gastrointestinal function by jejunal tube through the nose to give EN, amylase of serum and urine didn't rebound increased in anybody, after given 14 days of nutritional support, the white blood cell count, serum calcium concentration, serum amylase and urine amylase content had differences compared with own group when admission(P <0.05), there was a statistical significance; the ability of decreasing the white blood cell count in treatment group was better than the control group(P <0.05), there was a statistical significance. The serum albumin and prealbumin of treatment group were significantly higher than the control group (P<0.05) with a statistical significance. All this indicated when SAP giving early EN can effectively protect the intestinal mucosal barrier function, but also avoid the stimulation of pancreatic secretion from brain phase, stomach and intestinal phase,so that to maintain a static repaired state of the pancreas, more suitable for the physiological requirements of the pancreatitis'treatment. In addition, the combination of the early recovery of gastrointestinal function and early enteral nutrition had a significant effect in alleviating symptoms, reducing secondary infection rate, reducing the day number and cost in hospital, so it had a great society significance.Conclusions: 1. The combination of early recovery of gastrointestinal function and early EN can effectively promote the recovery of gastrointestinal function, protect the intestinal mucosa barrier function, reduce the bacterial number and fungal infection rate in patients with SAP; 2. Early implementation of EN was safe and effective, and it was the best time for its implementation when the general state was stable and entire or partial of gastrointestinal function recovered; 3. The combination of early recovery of gastrointestinal function and early EN can significantly reduced the course of SAP and the financial burden of patients.
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