| Objective: By comparing the influence of early nasogastric enteral nutrition(NGEN) and nasojejunal enteral nutrition NJEN) on severe acute pancreatitis(SAP) about state of an illness change, nutrition condition,intestinal permeability and prognosis, to explore the clinical efficacy, safety and tolerability of early nasogastric enteral nutrition(NGEN) on SAP.Methods: From 2013 November-2014 year in August the Affiliated Hospital of Luzhou Medical hospitalized patients met the diagnostic criteria of SAP patients 60 cases, randomly divided into nasogastric tube enteral nutrition group(NG group) 30 cases, nasojejunal enteral nutrition group(NJ group) 30 cases by using random number table. Group NG: Based on SAP basic treatment, early NGEN; group NJ: Based on SAP basic treatment, early nasojejunal enteral nutrition(NJEN). SAP enteral nutrition(EN) indications:(1) the recovery of intestinal function;(2) breathing;(3) the cycle stability. SAP-EN time: once the recovery of intestinal function(3-5 / min or bowel sounds recovery independent defecation) began to EN.Curative effect evaluation index:(1) Condition assessment: record APACHE II and MCTSI score on EN began 1st day and 7th day.(2) Intestinal permeability: on admission, EN began 1st day, 7th day,using ELISA method for the determination of endotoxin,D- lactic acid, diamine oxidase(DAO).(3) Indicators of inflammation: at the time of admission, EN began 1st day, third day, 7th day,determination of C- reactive protein(CRP) in blood routine test instrument; IL-6 and TNF- alpha were determined by ELISA method.(4) Assessment of nutritional status: EN started 1st day and 7th day, using automatic analyzer detection of two groups of patients of prealbumin(PA).(5) Recording EN side effects during the test: reflux aspiration, diarrhea and abdominal pain worse situation. Diarrhea Hart diarrhoea score method, the abdominal pain with VAS pain scoring criteria.(6) Conclusion the rate of infection complications, surgical rate,ICU rate, mortality,hospitalization time and hospitalization costs.Application of SPSS19.0 for statistical analysis.Results:(1) Condition assessment:a) APACHE II score: APACHE II score in NG group, NJ group, EN began 1st day were respectively 5.1±2.1, 4.5±2.6, 7th day were respectively 3.3±1.5, 3.2±1.8. There were no statistically significant difference between the two groups on 1st day and 7thday(P>0.05). But intra-group comparison results showed that APACHE II score in both groups were improved significantly earlier, the difference was statistically significant(P<0.001).b) MCTSI score: MCTSI score in NG group, NJ group, EN began 1st day were respectively 4.5±1.4, 4.8±1.2, 7th day were respectively 3.7±1.5, 3.9±1.4. There were no statistically significant difference between the two groups on 1st day and 7th day(P>0.05). But intra-group comparison results showed that APACHE II score in both groups were improved significantly earlier, the difference was statistically significant(P<0.001).(2) The intestinal permeability:a) Endotoxin: at the time of admission,NG group and NJ are measured on endotoxin were respectively 85.4±45.1 pg/ml, 74.5±24.6 pg/ml,;EN start day 1 were respectively 79.5±37.4 pg/ml, 72.5±31.5 pg/ml;EN start 7 days were respectively 81.2±42.9 pg/ml, 72.4±45.0 pg/ml, there were no statistically significant differences(P > 0.05).The intra-group comparison between day 1 and day 7 results showed that the differences had no statistical significance(P>0.05).b) D- lactic acid : NG and NJ group in D- lactic acid can be measured on admission were respectively 43.8±22.6 pg/ml, 54.0±21.7pg/ml;EN start day 1 were respectively 45.9±24.9 pg/ml,54.8±26.5 pg/ml;EN start day 7 were respectively 43.3±21.5 pg/ml, 55.2±28.4 pg/ml,there were no statistically significant difference between the two groups(P>0.05). The intra-group comparison between day 1 and day 7 results showed that the differences had no statistical significance(P>0.05).c) DAO : NG and NJ group measured DAO on admission were respectively 73.4±41.2 pg/ml, 92.2±37.5 pg/ml;EN start day 1 were respectively 96.4±50.5 pg/ml, 93.2±39.1 pg/ml;EN start 7 days were respectively 93.4±52.1 pg/ml, 75.0±33.6 pg/ml, The intra-group comparison between day 1 and day 7 results showed that differences in NJ group were significant(P=0.026). There were no statistically significant difference between the two groups(P>0.05).(3) Inflammation indicators:a) CRP : NG group and NJ to measure CRP on admission were respectively 105.3±89.0 mg/L, 98.1±75.6 mg/L;EN start day 1 were respectively 81.8±62.9 mg/L, 65.8±56.7 mg/L; EN start day 3 were respectively 52.7±44.2 mg/L,50.4±45.7 mg/L;EN start 7 days were respectively 28.8±mg/L, 24.0±26.3 mg/L. The intra-group comparison between day 1 and day 7 results showed that, 7 days after EN two groups of patients with CRP significantly reduced than the first day, the difference werestatistically significan(P<0.001). There were no statistically significant difference between the two groups(P>0.05).b) IL – 6: NG and NJ group measured IL- 6 on admission were respectively 45.1±24.4 pg/ml, 37.4±26.6 pg/ml;EN start day 1 were respectively 50.9 ±22.4 pg/ml, 65.5±74.3 pg/ml; EN start day 3 were respectively 48.6±21.3 pg/ml,46.2±23.5 pg/ml;EN start 7 days were respectively 45.4±29.6 pg/ml, 46.2±32.9 pg/ml, there were no statistically significant difference between the two groups(P>0.05). The intra-group comparison between day 1 and day 7 results showed that the differences had no statistical significance(P>0.05).c) TNF-α: NG and NJ group in measured on admission TNF-α were respectively 147.1±51.5 pg/ml, 132.1±45.9 pg/ml;EN start day 1 were respectively 133.5±54.8 pg/ml, 115.7±58.1 pg/ml; EN start day 3 were respectively 134.6±55.4 pg/ml,117.2±59.3 pg/ml;EN start 7 days were respectively 138.2±54.2 pg/ml, 122.8±54.4 pg/ml, there were no statistically significant difference between the two groups(P>0.05). The intra-group comparison between day 1 and day 7 results showed that the differences had no statistical significance(P>0.05).d) Nutrition status: NG and NJ group began to EN day 1 PA were respectively 125.9±45.9 g/L, 135.9±55.6 g/L, 7 days after ENwere respectively 172.6±45.3 g/L, 184.9±60.6 g/L, comparing differences in group between before and after EN treatment, significantly improve nutritional status, the difference was statistically significant(P<0.001),comparing differences between two groups of EN group before and after the start, no statistical significance(P > 0.05).(4) EN side effects: NG group of 6 patients with reflux aspiration, 3 cases of diarrhea, abdominal pain worse in 2 cases, a total of 11 cases;NJ group reflux aspiration in 1 case, 3 cases of diarrhea, abdominal pain aggravated in 3, a total of 7 cases.Overall the occurrence of side effects on difference between two groups has no statistical significance(P > 0.05).But in the comparison of reflux aspiration, NG group is higher than the NJ,the difference was statistically significant(P=0.044).(5) SAP clinical curative effect and prognosis evaluation:a) Infection complications: NG group was 33.3%(10 cases), NJ group was 53.5%(16 cases), there was no statistically significant difference between two groups(P=0.118).b) Turn surgical rate: NG group and NJ no 1 patients with SAP weredue to complications of surgery.c) Turn ICU rate: the research process, NG group because of acute respiratory distress syndrome(ARDS) turn ICU 2 example(6.7%),NJ group was 4 cases( 13.3%), there was no statistically significant difference between two groups(P>0.05).d) Mortality: 1 patient sudden death in the NG group, the mortality rate was 3.3%, while in NJ group, there were no deaths.e) NG and NJ group length of hospital stay were respectively 20.8±8.2 d, 21.5±9.3 d, there was no statistically significant difference(P > 0.05).f) Hospital costs, NG group and NJ group were respectively 4.9±2.1million 、 5.1±2.7million, two groups there was no statistically significant difference(P > 0.05).Conclusion: Early EN support on SAP, NGEN and NJEN have the similer effects on disease evolution, nutrition condition, intestinal permeability and prognosis.NGEN is simple and worthy of clinical attention.(2)The nasogastric may more easily lead to reflux aspiration than the nasojejunal. So think the security of the two ways on SAP still need more large sample randomized controlled trial study. |
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