Effects Of Sequential Early Enteral Nutrition In The Treatment Of Patients With Moderately Severe Acute Pancreatitis

Objective To investigate the effects of sequential early enteral nutrition(SEEN)on prealbumin(PAB),albumin(ALB),t cells(CD3~+,CD4~+),white blood cells(WBC),c-reactive protein(CRP),tumor necrosis factor ?(TNF-?),inter-Leukin(IL-6)and procalcitionin(PCT)in patients with moderate severe acute pancreatitis(MSAP),as well as the influence of clinical indicators such as gastrointestinal intolerance and hospital stay,provide a new way for enteral nutrition(EN)treatment of MSAP.Methods From May 2018 to July 2019,67 eligible patients in the general surgery department of our Hospital were randomly divided into group A and group B,namely33 patients in the sequential early enteral nutrition(SEEN)group and 34 patients in the early enteral nutrition(EEN)group.The Jejunal nutrition tube was placed under the electronic gastroscope in both groups and fixed on the head and face properly.After routine treatment,if the digestive system function of the patients is acceptable,then within 48 hours,patients in group A will be given SEEN support,and those in group B will be given EEN support.On the first day,the third day,the seventh day and the eleventh day,venous blood samples were collected from the two groups to detect PAB,ALB,CD3~+,CD4~+,WBC,CRP,TNF-?,IL-6,and PCT indicator,and to record the gastrointestinal intolerance and hospitalization days of the patients.The collected data were analyzed statistically and the differences between the two groups were compared.Results In the course of treatment,4 cases in group A were excluded due to the diagnosis of Severe acute pancreatitis(SAP)for organ failure lasting more than 48 hours,and 1 case was withdrawn from the study due to the requirement of automatic discharge;5 cases in group B were excluded due to the diagnosis of SAP for organ failure lasting more than 48 hours,and 1 case was transferred to ICU for further treatment due to severe infection and shock.The remaining 56 patients(28 in group A and 28 in group B)recovered successfully,that is to say,56 patients were finally included in the study.There was no significant difference in general basic data between the two groups(P>0.05).On the first day,the levels of PAB,ALB,CD3~+,CD4~+,WBC,CRP,TNF-?,IL-6 and PCT in group A and B were not significantly different(P>0.05);on the third day,the levels of WBC,CRP,TNF-?,IL-6 and PCT in group A were slightly lower than those in group B,with no statistically significant difference(P>0.05),while the levels of PAB,ALB,CD3~+ and CD4~+ were slightly higher than those in group B,with no statistically significant difference(P>0.0 5).On the 7th and11 th day,the levels of WBC,CRP,TNF-?,IL-6 and PCT in group A were significantly lower than that in group B,with statistically significant difference(P<0.05),and the levels of PAB,ALB,CD3~+ and CD4~+ were significantly higher than those in group B,with statistically significant difference(P<0.05);The incidence of gastrointestinal intolerance and hospitalization days in group A were significantly lower than those in group B(P < 0.05).Conclusion 1.Compared with EEN,SEEN for MSAP patients is more helpful to reduce the incidence of gastrointestinal intolerance and hospital stay.2.Compared with EEN,SEEN can promote protein synthesis faster and better,improve systemic inflammatory response and immune dysfunction,and accelerate the recovery of patients.