Clinical Study On The Effect Of The Timing Of Enteral Nutrition Initiation On The Prognosis Of Severe Acute Pancreatitis

Objective:Analysis of enteral nutrition startup time effect on the prognosis of severe acute pancreatitis, early enteral nutrition for the treatment of SAP, evaluation of early enteral nutrition startup time in SAP clinical value and significance.Methods:Retrospective analysis of the January 2012 to December 2014, the First Hospital of Shanxi Medical University, Division of Critical Care Medicine SAP admitted 57 patients.According to whether patients admitted to hospital after start of enteral nutrition within48 h, will be divided into early enteral nutrition group(early enteral nutrition, EEN)(30cases) and delayed enteral nutrition group(Delayed enteral nutrition, DEN)(27 cases).Were detected before treatment(day of admission) and section 5d, 9d, 14 d of the white blood cell count, serum albumin, blood lymphocytes and analyzed to calculate the value of the three indicators of change after treatment. Record comparison of pancreatic infection,pancreatic pseudocyst, pneumonia, respiratory failure, renal failure, MODS, bacteremia,case fatality rate, average total length of hospital stay, average living ICU days and average hospitalization expenses.Results:EEN group at 5 days after treatment, 9 days and 14 days respectively for the white blood cell count 13.37±3.94(109/L),10.73±2.40(109/L),8.74±1.57(109/L) than in DEN group was significantly decreased(P <0.05); EEN group lymphocyte count was in the 5th and 9th day after treatment 1.47±0.60(109/L), 2.06±0.62(109/L) compared with DEN group of 0.96±0.48(109/L),1.39±0.41(109/L) showed a gradual rising trend(P <0.05), EEN group14 days value [2.18±0.45(109/L)] higher than DEN group [2.00±0.41(109/L)], thedifference was not statistically significant(P> 0.05); EEN serum albumin in the treatment of the first 5 days, 9 days and 14 days respectively 33.99±3.34(g/L),37.19±3.41(g/L),44.32±4.15(g/L) increased rate significantly higher than the DEN group(P <0.05); EEN group of patients with pancreatic infection(10%) was significantly lower than DEN group(44.4%)(P <0.05); compared with DEN group, EEN group of pneumonia, respiratory failure, MODS group were significantly lower than DEN(20% higher than 48.1%, 10%higher than 33.3%, 13.3% more than 44.4%, P <0.05); and EEN group, the average length of stay, the average number of days in ICU, the average total cost of hospitalization was significantly reduced compared with DEN group(P <0.05).Conclusions:For SAP patients with early(<48h) nasal feeding tube to start enteral nutrition can improve the nutritional status of patients, regulate high catabolic state with excessive inflammatory stress response, improve immunity, reduce pancreatic infection, pneumonia,respiratory failure, MODS occurs, shorten hospital stay, reduce hospital costs.