Clinical Study Of Enhanced Recovery After Surgery In Severe Acute Pancreatitis

[Objective]To explore the safety of the concept of enhanced recovery after surgery applied in patients with severe acute pancreatitis and its effect on inflammatory response,nutritional status and gastrointestinal function recovery.[Methods]Data of severe acute pancreatitis patients admitted to The Second Affiliated Hospital of Dalian Medical University within 24 hours from November 2017 to November 2019 were retrospectively collected and analyzed.A total of 41 patients met the inclusion and exclusion criteria of this study,among which 18 were treated by ERAS concept and 23 were treated by traditional methods,respectively set as ERAS group and control group.Patient data included: general clinical data(age,sex,body mass index),biochemical indicators(serum amylase,C-reactive protein,white blood cell and albumin levels on the day of admission,day 3,day 5,day 7 and day 10),Acute physiology and chronic health ?(APACHE-?)score,grade of acute gastrointestinal injury(AGI),numerical rating scale(NRS),indicators of gastrointestinal function recovery(time for remission/relief of nausea and vomiting,time for bowel sounds to recover,time for anal exhaust,time for relief of abdominal distension to relieve),complications(pulmonary infection,MODS),mortality,hospitalization(time for resume diet,time for discontinue intravenous nutritional support,length of hospitalization,hospitalization costs).The above clinical data were analyzed statistically.The measurement data were expressed as (?) ±s,and t test was used to compare the difference between the two groups.The enumeration data were expressed by percentage,and the comparison between the two groups was conducted by ?~2 test or Fisher's exact probability test.In all statistical analyses,statistical significance in two-side tests was indicated as P?0.05.[Results]1.The general clinical data,the levels of serum amylase,C-reactive protein,white blood cells and albumin on the day of admission,the APACHE-? score,grade of AGI and NRS score on the day of admission,were no statistically significant difference between the ERAS group and the control group.2.Biochemical indicators: Serum amylase: The overall levels of serum amylase in the ERAS group and the control group decreased significantly after admission,but there was no statistically significant difference between the two groups.C-reactive protein:Compared with the control group,the level of C-reactive protein in the ERAS group significantly decreased on the 5th,7th and 10 th days after admission,with statistically significant differences between the two groups(P < 0.05).White blood cells: Compared with the control group,the leucocyte levels in the ERAS group significantly decreased on the 7th and 10 th day after admission(P < 0.05).Albumin: Compared with the control group,the albumin level in the ERAS group was significantly increased on the 5th,7th and 10 th days after admission(P < 0.05).3.APACHE-? score,AGI score and NRS score: The APACHE-? scores of ERAS group appeared decreasing significantly on the 7th and 10 th day after admission comparing the control group,with statistically significant difference(P < 0.05).Compared with the control group,the AGI scores of patients in the ERAS group were significantly decreased on the 5th,7th and 10 th days after admission,And the differences between the two groups were significant statistically(P < 0.05).Compared with the control group,the NRS score of patients in the ERAS group significantly decreased on the 3th,5th,7th and 10 th days after admission,with statistically significant differences(P < 0.05).4.Gastrointestinal functional recovery and complications: The recovery time of gastrointestinal functional indicators in the ERAS group was significantly shorter than that in the control group(P < 0.05).There was no significant difference in the incidence and mortality of infection-related complications between the ERAS group and the control group.5.Hospitalization: the time of resume diet,cessation of intravenous nutrition support and length of hospitalization in the ERAS group were significantly shorter than those in the control group(P < 0.05),and the hospitalization cost was significantly less than those in the control group(P < 0.05).[Conclusion]It is safe to apply the ERAS concept into SAP patients without enteral nutrition contraindication,which can reduce inflammatory response,improve the nutritional status of patients,accelerate the recovery of gastrointestinal function,shorten the length of stay and reduce the cost of hospitalization.Finally,the goal of rapid recovery could be achieved.