ABSTRACT
Objective To compare the efficacy and clinical value of early enteral immunonutrition (EIN) combined with glutamine with early standard formula enteral nutrition (EEN) in patients with severe acute pancreatitis(SAP).Methods Twenty-eight patients with SAP were divided into two groups by random number table.Both groups were fasted,given treatments of anti-infection,gastrointestinal decompression,acidoresistance,spasmolysis,pancreatic enzyme inhibition,reduce the burden on the pancreas insulin,water electrolyte balance and parenteral nutrition upon admission into hospital.Spiral nasointestinal tube was implemented within 72 hours of patients' admission.The 14 cases in the EEN group were given treatment of early standard enteral nutrition by nasojejunal tube.The 14 cases in the EIN group received early enteral immunonutrition (glutamine granules,0.2 g/(kg · d),at least three times oral administration by dissolving in enteral nutritious agent peptison with a small amount of warm water).During the treatment,the dose of glutamine granules was reduced gradually until withdrawal when the patients in the EIN group started normal diet.The changes were observed in patients in terms of APACHE Ⅱ,Ranson score,inflammatory markers,nutritional and immune indicators,while monitoring the first defecation time,ICU care unit stay,total hospital stay,total hospitalization costs,complication rate and mortality data.Results Patients of both groups tolerated early enteral nutrition treatment.Fourteen days after treatment,the value of the immune indicator IgG was significantly higher in the EIN group than in the EEN group((19.14 ± 2.03) g vs.(13.79 ± 3.29) g,P ＜0.05).The first defecation time,ICU care days,total hospital costs were significantly shorter or less in patients in the EIN group than in those in the EEN group (first defecation time:((4.29 ± 1.64) d vs.(5.36 ± 0.84)d,t =2.179 ; ICU care:(2.57 ± 0.85) d vs.(3.64 ± 1.60) d,t =2.213 ; total hospital costs:(343.6 ±35.9)thousand yuan vs.(438.6±94.3) thousand yuan,t =3.518; P ＜0.05).Conclusion It is feasible and safety to implement EIN treatment in patients with severe acute pancreatitis.EIN and EEN could significantly reduce the inflammatory response and improve the nutritional status of patients with severe acute pancreatitis.But EIN is better in improving immune function and the prognosis of patients with severe acute pancreatitis than the EEN.
ABSTRACT
Objective To investigate the effect of detail management in ward drug administration.Methods Details management for ward drug management were applied,including the standardization of the drug storage,storage method,to carry out new knowledge learning,to strengthen the drug management,to set up the standardized nursing medication process identification and optimization measures.Results details management,the incidenues of drug mixed and delayed delivery were lower;the time of checking drug was significantly shorter(P<0?001).Conclusions The details management are the effective measures to ensure drug quality and safety.