Résumé
Objective:To explore the clinical efficacy,safety and tolerability of nasogastric enteral nutrition (NGEN) on moderate-severe acute pancreatitis (M-SAP).Methods:Sixty patients diagnosed as M-SAP and admitted admitted to Department of Gastroenterology,Affiliated Hospital of Southwest Medical University from November 2013 to August 2014 were randomized to receive enteral nutrition (EN) via a nasogasteic tube (n =30) or a nasojejunal tube (n=30).The intestinal permeability (endotoxin,D-lactic acid),inflammation index (CRP、IL-6、TNF-α),nutrition status,nutrition-related adverse effects (reflux aspiration,diarrhea and abdominal pain worse situation),condition assessment (APACHE Ⅱ and MCTSI),and prognosis (infection complications,mortality,length of hospital stay,hospital expenses)were collected and compared.Results:There was no statistically significant difference in the two groups as for intestinal permeability,inflammation index,evaluation of nutritional status,overall condition assessment,and prognosis (P ＞ 0.05).On the reflux aspiration,the rate of nasogastric tube enteral nutrition group (NG group) was 20％,nasojejunal enteral nutrition group (NJ group) was 3.3 ％,the difference was statistically significant (P ＜ 0.05).Conclusion:Either NGEN or NJEN has the similar effects on disease evolution,nutrition condition,intestinal permeability and prognosis of M-SAP.NGEN is simple and worthy of clinical attention.The nasogastric may more easily lead to reflux aspiration than the nasojejunal route.It requires more randomized controlled study to investigate its safety on SAP.
Résumé
Objective To evaluate the clinical value of the three-category classification of severe acute pancreatitis (SAP).Methods Clinical data of 337 traditional SAP patients,who were admitted to Peking Union Medical College Hospital (PUMCH)from January 2001 to December 2012,were retrospectively studied.These patients were classified into moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) according to the latest 2013 Atlanta Classification.SAP patients were further categorized as critical acute pancreatitis (CAP) and non-CAP.Disease severity,therapy and prognosis among three groups were compared.Results Among the total 337 traditional SAP patients,253 were classified as MSAP and 84 as SAP.In the group of SAP,40 patients were categorized as CAP and 44 as non-CAP.Compared with non-CAP patients,CAP patients had significantly higher mortality rate which was 70％ (28/40).Other results were all significantly higher in CAP group rather than non-CAP group,including ICU admission rate 77.5％(31/40),length of ICU stay (15.5 ± 20.6) days,Ranson,APACHE Ⅱ,BISAP,MCTSI,modified Marshall scores 4.6 ± 1.4,16.8 ± 5.8,3.0 ± 1.0,8.6 ± 1.7,and 7.4 ± 2.9,respectively (P ＜ 0.01 in each endpoint).These parameters of SAP group were also significantly higher than those of MSAP group (P ＜0.01).Conclusions Using the new three-category classification to distinguish traditional severe acute pancreatitis,namely MSAP,SAP,and CAP,can better reflect the severity of disease,predict outcome and guide clinical management.