Application Of Enteral Nutrition In Elderly Patients With Acute Severe Cholangitis After ERCP

Research background:Acute severe cholangitis is a serious biliary tract infection with rapid onset,rapid development and high mortality.The disease is accompanied by biliary obstruction,which requires immediate biliary drainage to relieve biliary obstruction,otherwise it may cause septic shock and even death.The human body is in a state of stress,so the demand for energy increases.The elderly due to the degradation of the body function,so that their absorption and decomposition of nutrients obstacles,prone to malnutrition.Clinical studies indicate that 49.4%of elderly people hospitalized for acute disease are at risk of malnutrition.Malnutrition also leads to a higher rate of complications and mortality in acute severe cholangitis than in other age groups.Enteral nutrition conforms to human physiology,maintains the integrity of intestinal function and barrier,and regulates human immune function.In this study,elderly patients with acute severe cholangitis were selected as subjects,and the nutritional status,liver function,inflammatory reaction,length of stay,cost,complication rate and mortality of such patients were taken as the observation indexes to discuss the efficacy of enteral nutrition in elderly patients with acute severe cholangitis.Objective:We observe the effect of enteral nutrition on nutritional status,liver function,inflammatory reaction,length of stay,cost,complication rate and mortality in elderly patients with severe cholangitis,and then we explore its clinical value in the treatment of acute severe cholangitis in elderly patients.Method:We did a retrospective analysis in our hospital from January 2016 to May 2018.In the study,clinical data of 43 patients(treatment group)over 65 were reviewed and compared with those of 43 matched patients(control group)at a 1:1 ratio.The nutritional status,liver function indexes,inflammatory response,length of stay,hospitalization cost,complication rate and mortality of patients in the two groups were analyzed.Results:1.The length of hospital stay were(16.0±7.0 days)vs(19.3±3.7days)and hospitalization costs were(40059±10412 yuan)vs(53396±23006 yuan)in the treatment group were both lower than those in the control group,and the difference was statistically significant(P<0.05).2.Three days later,the white blood cell counts of patients in the control group and the treatmentgroupwererespectively(8.9*10~9/L±8.0*10~9/L)VS(11.4*109/L±10.2*109/L)(P=0.20).The neutrophil percentages were(73.0%±12.2%)VS(74.6%±14.8%)(P=0.60).The hemoglobin levels were(111.7g/L±19.2g/L)VS(105.2g/L±15.3g/L)(P=0.09).The CRP values were(65.3mg/L 52.0mg/L)VS(74.6mg/L±14.8mg/L)(P=0.14).The total proteins were(60.5g/L±6.4g/L)VS(64.2g/L±5.2g/L)(P=0.004).Albumin was(30.1g/L±4.8g/L)VS(30.5g/L±3.4g/L)(P=0.62).The AST values were(67.3U/L±56.2U/L)VS(41.4U/L±52.2U/L)(P=0.03).The ALT values were(69.7U/L±66.2U/L)VS(25.4U/L±15.1U/L)(P<0.001).3.Seven days later,the white blood cell counts of patients in the control group and the treatment group were respectively(9.0*10~9/L±5.8*10~9/L)VS(10.4*10~9/L±7.2*10~9/L)(P=0.31).The neutrophil percentages were(74.9%±11.7%)VS(74.9%±13.0%)(P=1.00).The hemoglobin levels were(111.9g/L±22.4g/L)VS(105.7g/L±15.0g/L)(P=0.14).The CRP values were(51.4mg/L±46.5mg/L)VS(29.2mg/L±17.1mg/L)(P=0.005).The total proteins were(64.5g/L±5.7g/L)VS(67.6g/L±5.4g/L)(P=0.01).Albumin was(31.5g/L±7.0g/L)VS(34.6g/L±3.7g/L)(P=0.02).The AST values were(32.2U/L±19.3U/L)VS(45.3U/L±34.3U/L)(P=0.03).The ALT values were(98.4U/L±372.9U/L)VS(25.4U/L±17.1U/L)(P=0.21).4.The incidence of diarrhea in the control group and the treatment group after nutritional support was respectively 4.6%VS 32.6%(P=0.001).The incidence of abdominal distension was 7.0%VS 30.2%(P=0.006).5.The mortality rates of control group and treatment group were respectively 9.3%VS 11.5%(P=0.62).Conclusions:ERCP combined enteral nutrition support will not be able to reduce the mortality of elderly patients with acute severe cholangitis,at the same time,some patients suffer from gastrointestinal adverse reactions such as diarrhea and abdominal distension,but enteral nutrition can reduce inflammatory reaction,improve the nutritional status of patients,reduce the patient's hospital stay,reduce the economic burden of patients.