Clinical Study On Treatment Of Severe Acute Pancreatitis With Rude Rhubarb By Nasojejunal Feeding

Objective The aim is to compare the difference on inflammatory response,biochemical indicators and clinical indicators of rude rhubarb in the treatment of severeacute pancreatitis(SAP) by nasogastric or nasojejunal feeding. Explore the clinicalefficacy of rude rhubarb in the treatment of SAP by nasojejunal feeding.Methods45SAP patients we selected from August2010to February2013whichrandomly divided into experimental group (n=23) and and control group (n=22)Gastric tube or nasojejunal tube were placed on all patients within1hour.All Patientswere treated with routine therapy including Intensive care,fasting,acid suppression,inhi-bition of pancreatin secretion,fluid infusion to replacement of blood volume,maintainingelectrolyte and acid base balance,usage antibiotics,nutritional support, Control groupwere given rude rhubarb by nasogastric feeding,while those in experimental group weregiven rude rhubarb by nasojejunal feeding.To compared the difference on theAPACHEⅡscore,Balthazar-CT score,the serum levels of IL-1, IL-6,bacterialendotoxin and White blood cell count at different interval(1,7d).Observe and comparethe recovery time on the level of serum C-reactive protein(CRP),serum amylase,anusrestore to exhaust time and complication rate.Analysis the efficacy of rude rhubarb inthe treatment of SAP by nasojejunal feeding.Results (1) The experimental group and control group have significant differenceson recovery time of serum C-reactive protein and serum amylase[6.74±1.42d and 5.78±1.04d vs8.00±1.63d and6.82±1.22d](P<0.05).The serum CRP, serum amylaserecovery time significantly earlier than the control group.(2) The anus restore to exhausttime is3.30±0.97on the experimental group,the control group is(4.68±0.89)d,theexperimental group anus restore to exhaust time significantly earlier than control group(P<0.05).(3) In the7d of treatment,the APACHE Ⅱscore is (4.48±1.44) on theexperimental group,the control group is(5.32±1.04),the experimental group significantlylower than the control group(P<0.05),The experimental group decrease of (6.26±2.86),the control group decrease of (4.77±1.77),The decline of the experimental group wassignificantly greater than that of the control group.In the7d of treatment,the BalthazarCT score is(2.57±1.38) on the experimental group,the control group is (2.95±1.05),Twogroups showed no significant difference(P>0.05).The experimental group decreaseof(3.04±2.10),the control group decrease of (2.36±1.50),There was no significantdifference between the two group(P>0.05).(4) In the7d of treatment.The experimentalgroup and control group have significant differences on the serum IL-1,IL-6andbacterial endotoxin[28.76±7.36pg/ml and33.56±8.13pg/ml and21.03±13.67pg/ml vs34.80±7.71pg/ml and38.33±6.42pg/ml and33.23±14.15pg/ml](P<0.05),and comparedto admission were significantly lower(P<0.05),The experimental group and controlgroup have significant differences on the decline of IL-1,IL-6and bacterialendotoxin[30.00±10.65pg/ml and38.30±9.41pg/ml and97.96±28.12pg/ml vs19.13±7.94pg/ml and28.58±11.19pg/ml and78.37±26.94pg/ml](P<0.05).(5) In the7d oftreatment. The white blood cell count on the experimental group is(12.28±2.28)×109/L,and the control group is(16.53±2.48)×109/L,the experimental group significantly lowerthan the control group(P<0.05).(6) The complication rate was21.7%in theexperimental group,and the control group was50.0%,The experimental group wassignificantly lower than the control group on complication rate(P<0.05).Conclusion (1) Application of rude rhubarb by nasojejunal feeding can make serum CRP, serum amylase returned to normal earlier.(2)Application of rude rhubarb bynasojejunal feeding can early elimination of intestinal paralysis, recovery of intestinalfunction.(3) Application of rude rhubarb by nasojejunal feeding can reduce theAPACHE-II score, but no significant advantage on the reduce of Balthazar CTscore.(4) Application of rude rhubarb by nasojejunal feeding can effectively control thesystemic inflammation,reduce bacterial translocation of intestinal bacteria andendotoxins.(5) Application of rude rhubarb by nasojejunal feeding can reduce the whiteblood cell count.(6) Application of rude rhubarb by nasojejunal feeding can reduce theincidence of complications.By the nasojejunal feeding way injection rude rhubarb onthe treatment of SAP is a more effective route of administration, worthy of promotion.