A Meta-analysis Of Efficacy Of Enteral Nutrition And Parenteral Nutrition In Patients With Severe Acute Pancreatitis

Objective:Severe acute pancreatitis(SAP) is a kind of common acute abdominal disease,clinical progress go quickly and the case fatality rate is high and patients is extremely dangerous. Patients with SAP often accompanied by systemic inflammatory response syndrome(SIRS), the serious inflammatory response often makes the body catabolism increased obviously, energy consumption is significantly higher. At the same time,Patients with SAP will cause the body’s nutrients of energy reserves rapid loss, and can also lead to the metabolism of water and electrolyte acid-base balance disorders. So,nutritional support in patients with SAP is very important. The nutritional support treatment are respectively enteral nutrition(EN) and parenteral nutrition(PN). Intestinal mucosal barrier function in patients with enteral nutrition can protect from damage, reduce enterogenous infection complications, but in the process of application of enteral nutrition may cause gastrointestinal discomfort, including diarrhea, abdominal distension. And parenteral nutrition does not stimulate pancreatic juice secretion, lighten the burden of gastrointestinal tract, can obviously improve the nutritional status of patients, but parenteral nutrition may lead to increase the incidence of enterogenous infection and catheter related infections. Application of Meta analysis evaluate the treatment efficacy and safety of enteral nutrition and parenteral nutrition in severe acute pancreatitis(SAP), provide a basis for evidence-based medicine in clinical. Methods:Computer retrieval Pub Med, Wanfang Data knowledge service platform,C hina hownet(CNKI), retrieve the fixed number of year from libraries to 2015 January. Included in all relevant EN and PN randomized controlled trials for the treatment of SAP, at the same time all checked out documents of reference as a supplement. By reading title, abstract or the full text literature, According to the inclusion/ exclusion criteria, the use of double parallel excerpt methods were carried out by two researchers, and cross-checking, when disagreements were resolved by discussion or by a third party to decide. For lack of information through the contact author to complement, the data is the literature basic information, including the number of patients, characteristics, intervention, outcome indicators and so on. Choose the case fatality rate, incidence of infection, the incidence of multiple organ failure, surgical intervention rate, average length of hospital stay in patients with SAP as a final analysis indicators. On into the research of RCT quality evaluation and data extraction, then use Rev Man 5.3 software to complete the statistical analysis. Results:According to the selection criteria, nine articles were included in the study, a total of 450 patients were selected, the EN group 220 examples, the PN group 230 examples. The baseline characteristics of two groups were similar. All the patients with S AP in EN group were via nasal jejunum distal ways enteral nutrition, the start time for admission within 24h-72 h.The Meta statistical showed as follow: Compared with PN group, EN group of patients with SAP, fatality rate reduction(RR = 0.43, 95% CI(0.23,0.78), P = 0.006), the difference was statistically significant;Pancreatic infection and complication rate reduction(RR = 0.56, 95% CI(0.42, 0.77), P = 0.0002), the difference was statistically significant;Surgical intervention rate reduction( RR = 0.52, 95% CI(0. 36,0.74), P = 0.0003), the difference was statistically significant; In respect of incidence of multiple organ failure(RR = 0.61, 95% CI(0.25, 0.25), P = 0.27), there was no statistically significant difference.And in terms of average hospitalization time,there was no statistical difference between EN and PN group(WMD =0.73, 95% CI:(-9.23,10.69, P = 0.89). Conclusion:The present study demonstrates : Early application of enteral nutrition can significantly reduce the mortality of patients with SAP, can obviously reduce the incidence of infection and complication, can significantly decrease the rate of surgical intervention, the prognosis of patients. Therefore, patients with SAP, in the absence of enteral nutrition contraindications,early enteral nutrition should be the first selection as nutritional support.