Effect Of Early Enteral Nutrition Combined With Microecological Preparation On Patients With Severe Acute Pancreatitis:A Meta-analysis

Objective: As one of the critical clinical diseases,severe acute pancreatitis is the most severe type of acute pancreatitis.The early morbidity and mortality of patients can be attributed to organ failure secondary to systemic inflammatory response syndrome,and enterogenous bacterial infection is the main cause of death in the remaining death cases.Enteral nutrition can maintain the integrity of the intestinal function,reduce inflammation,reduce patient mortality,many scholars say probiotics is added in the enteral nutrition than simple application of enteral nutrition curative effect is better,so this kind of way of nutritional support in the treatment of patients with severe acute pancreatitis has been widely discussed,but its specific curative effect and value.This paper used meta-analysis to analyze the effect of early enteral nutrition combined with microecological agents in the treatment of severe acute pancreatitis,and to evaluate its effectiveness,so as to provide evidence-based medicine basis for clinical practice.Methods: Retrieval China journal full-text database(CNKI),Chinese biomedical literature database(CBM),ten thousand,Weipu database(VIP),the Cochrane Library,PubMed,Embase and Web of science,collection building up to November 1,2019 joint probiotics on early enteral nutrition in severe acute pancreatitis patients curative effect of randomized controlled trials.Relevant studies were included in strict accordance with the inclusion and exclusion criteria,and their quality was evaluated,from which original research data were extracted,such as length of stay,mortality,incidence of complications,incidence of pancreatic necrosis infection,incidence of MODS,and CRP level results of patients with acute severe pancreatitis.The RevMan5.3 software was usedfor statistical analysis to compare the differences and similarities in the results of hospitalization time,mortality,incidence of complications,incidence of pancreatic necrosis infection,incidence of MODS and CRP level between the enteral nutrition combined with microecological preparation group and the enteral nutrition group.Results: A total of 1060 patients with acute severe pancreatitis were included in the 12 randomized controlled trials,with 536 in the test group and 524 in the control group.For patients with acute severe pancreatitis,early enteral nutrition combined with microecological preparation,compared with enteral nutrition alone,can shorten the length of stay [WMD=-4.49,95%CI :(-7.05,-1.93),P=0.0006],reduce the incidence of complications [RR=0.71,95%CI :(0.57,0.87),P=0.001] and the incidence of pancreatic infection and necrosis [RR=0.65,95%CI :(0.47,0.90),P=0.01].There were no statistically significant differences in mortality [RR=1.02,95%CI :(0.67,1.55),P=0.93],CRP level [WMD=-5.59,95%CI :(-20.90,9.72),P=0.47],and MODS incidence[RR=0.72,95%CI :(0.49,1.07),P=0.10].Conclusion : Early enteral nutrition combined with microecological agents can effectively shorten the hospitalization time of patients with acute severe pancreatitis,reduce the incidence of complications and the incidence of pancreatic infection and necrosis,so this treatment method may be more beneficial for patients with severe acute pancreatitis.However,according to the current data,it cannot be confirmed that it can reduce mortality,CRP level and the incidence of MODS in patients with acute severe pancreatitis.Therefore,large-scale,high-quality,placebo-controlled,double-blind trials are still needed in the future to clarify the role of early enteral nutrition combined with microecological agents in the treatment of patients with severe acute pancreatitis.It should also be noted that the types,dosages,and treatment strategies of microecologic agents used in different study designs vary widely,so it is important to carefully consider which microecologic agents to use,the appropriate dosages of microecologic agents,early initiation time,and duration of treatment before conducting clinical trials.Furthermore,given the risks associated with certain microecological agents,further clinical trials should be carefully designed to avoid any potentially harmful effects.