Comparison Of Early Enteral And Parenteral Nutrition After Pancreaticoduodenectomy And Total Parenteral Nutrition

Objective: To investigate the application value of combined enteral and parenteral nutrition after pancreaticoduodenectomy compared with total parenteral nutrition.Methods: Clinical data of patients who underwent pancreaticoduodenectomy in the Hepatobiliary Department of the People’s Hospital of Ningxia Hui Autonomous Region from January 2018 to December 2020 were retrospectively analyzed,they were divided into two groups according to inclusion and exclusion criteria,the observation group received 30 enteral nutrition(EN)combined with parenteral nutrition(PN),and the control group received 40 patients were treated with total parenteral nutrition(TPN).The general data,preoperative indexes,intraoperative indexes and postoperative indexes of patients in the two groups were compared and analyzed statistically to explore the application value of enteral combined parenteral nutrition after pancreaticoduodenectomy compared with total parenteral nutrition.Results: The preoperative blood routine(hemoglobin count,white blood cell count,neutrophil count),biochemical indexes(alanine aminotransferase,aspartate aminotransferase,total protein,albumin,prealbumin,total bilirubin,direct bilirubin,indirect bilirubin),tumor markers(AFP,CEA,CA153,CA125,CA199),history of diabetes,hypertension,coronary heart disease,BMI,compared with TPN group,the difference was not statistically significant(p > 0.05).The nutritional indexes(total protein,albumin,hemoglobin)had no significant difference on postoperative day 1 and 4,but significantly decreased on postoperative day 7(p= 0.027,0.028,0.010,respectively);prealbumin had significant difference on postoperative day 3and 7(p = 0.027,0.001,respectively)(p < 0.05).There was no significant difference in inflammatory indexes(leukocytes and neutrophils)on the 1st day after operation(p >0.05),but they decreased significantly on the 4rd and 7th day after operation,and the difference was statistically significant(p < 0.05).The difference in the incidence of postoperative complications was statistically significant(p < 0.05).The difference of postoperative exhaust time,hospital stay and intraoperative hospital stay(p = 0.022,0.024)were statistically significant.There was no significant difference in body temperature and peritoneal drainage fluid at 1 day,4 days and 7 days after operation(p > 0.05).The changes of liver function indexes(ALT,AST,TBIL,DBIL)with time were statistically significant between the two groups(p < 0.05).Conclusion:Compared with parenteral nutrition alone,combined enteral and parenteral nutrition can improve nutritional indicators and liver function indicators,reduce infection indicators,reduce the incidence of complications,and shorten the hospital stay.