Clinical Effect Of Enteral Nutrition On Severe Acute Pancreatitis

Objective:Severe acute pancreatitis accounted for 5-10%of acute pancreatitis with systemic inflammatory response syndrome(SIRS).The case fatality rate is 36-50%[1].Nutrition support is an important step in the treatment of SAP patients with such a high metabolize and high decomposition state.The purpose of this study was to compare the effects of total parenteral nutrition(TPN)and sequential parenteral-enteral nutrition(PN+EN)on the prognosis of SAP,to compare the effects of different starting time on the prognosis of SAP,to evaluate the clinical signification of early enteral nutrition.Methods:From January 2014 to February 2019,58 patients with severe acute pancreatitis were admitted to the First Affiliated Hospital of Kunming Medical University.TPN group and PN+EN group according to the post-hospital nutrition support method.By comparing two groups'level of amylase,lipase,inflammatory makers,hepatic and renal function,GLU,serum calcium,APACHE ? score,average total length of hospital stay,the incidence of complication and mortality on the 1st day and the 14th day.PN+EN group was divided into early enteral nutrition group(EEN)and delay enteral nutrition(DEN)group.The inflammatory makers,hepatic and renal function,GLU,serum calcium,APACHE ? score,average length of hospital stay,the incident of multiple organ failure and mortality were compared between the two groups before treatment and on the 14th day of treatment.Results:(1)There were no signification differences between TPN and EN groups in sex ratio(18/14 and 15/11),age(46.57±13.80 and 45.77±11.78),APACHE II score(13.81±3.84 ? 14.47±4.05)and the cause of disease(all P>0.05).(2)On day 14,WBC count was 7.07(5.08,10.10),PCT was 0.62(0.75,2.03),which in the EN group was significantly lower than that in the TPN group(P<0.05).(3)On day 14,CRP,PCT and blood calcium were 8.3(3.95,11.53),0.71(0.34,0.89),2.24±0.12 after 14 days treatment in EEN group,there was a statistical difference(P<0.05).(4)Compared with TPN group,the average length of stay,local complications and sepsis rate in EN group were signification lower(P<0.05).The incidence of ARDS and MODS decreased,but there was no statistical difference(P>0.05).(5)The average length of stay in the TPN and EN groups was 32.0(27.5,38.25)and 18.0(14.0,21.0),there were statistical difference(P<0.05).(6)There was no significant difference in mortality between TPN and EN groups,EEN and DEN groups(P>0.05).Conclusion:Enteral nutrition can effectively reduce the production of inflammatory factors,reduce the incidence of infection and shorten the average length of hospital stay for severe acute pancreatitis patients.The timing of enteral nutrition initiation had no significant effect on the prognosis of patients with SAP.