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Clinical application of endoscopic nasobiliary drainage combined with nasojejunal tube feeding in elderly patients with severe acute cholangitis / 中华消化内镜杂志
Chinese Journal of Digestive Endoscopy ; (12): 817-822, 2021.
Article in Chinese | WPRIM | ID: wpr-912179
ABSTRACT

Objective:

To evaluate endoscopic nasobiliary drainage (ENBD) combined with nasojejunal tube feeding for elderly patients with severe acute cholangitis.

Methods:

Data of 43 elderly patients with severe acute cholangitis, who received ENBD combined with nasojejunal tube feeding from January 1, 2016 to May 31, 2018 at Affiliated Hangzhou First People′s Hospital, Zhejiang University School of Medicine were retrospectively analyzed and were included in the observation group, and 43 other patients who received ENBD combined with conventional therapy in the same period were included in the control group with the matching principle of 1∶1. Liver function indices (ALT and AST), nutritional status (Hb, TP and ALB) and inflammation indices (WBC, NEU% and CRP) of the two groups before the operation, 3 days and 7 days of nutritional support after the operation were compared. Adverse reactions (abdominal distention and diarrhea), mortality, hospitalization time and expenses of the two groups were also compared.

Results:

There were no significant differences in gender composition, mean age, preoperative APACHE-Ⅱ score, NRS2002 score, liver function index, nutritional index, or inflammatory index between the observation group and the control group ( P>0.05). The baseline data of the two groups were comparable. After 3 days of nutritional support, ALT, AST, TP were 21.0 (15.0, 35.5) U/L, 26.0 (21.0, 36.5) U/L, and 64.2±5.2 g/L, respectively in the observation group, and 47.0 (29.5, 82.5) U/L ( P<0.05), 47.0 (29.0, 75.0) U/L ( P<0.05), and 60.5±6.4 g/L ( P<0.05), respectively in the control group. The levels of other indicators were not statistically different at this time point ( P>0.05). At 7 days postoperative nutritional support, ALT, AST, TP, ALB and CRP of the observation group were 22.0 (14.0, 31.5) U/L, 26.0 (20.5, 38.5) U/L, 67.6±5.4 g/L, 34.6±3.7 g/L, and 28.0 (18.5, 35.5) mg/L, respectively, and 43.0 (18.0, 59.5) U/L ( P<0.01), 34.0 (24.0, 60.5) U/L ( P=0.02), 64.5±5.7 g/L ( P=0.01), 31.5±7.0 g/L ( P=0.02), and 34.0 (24.0, 66.5) mg/L ( P<0.05) in the control group. There were no significant differences in the levels of other indicators between the two groups at this time point ( P>0.05). In the observation group, the incidence of diarrhea, abdominal distension, mortality, hospitalization time and hospitalization expenses were 32.6% (14/43), 30.2% (13/43), 9.3% (4/43), 16.0±7.0 days and 40±10 thousand yuan, respectively, and in the control group, the above indicators were 4.7% (2/43) ( P<0.05), 7.0% (3/43) ( P<0.05), 11.6% (5/43) ( P=0.72), 19.3±3.7 days ( P<0.05)) and 53±23 thousand yuan ( P<0.05), respectively.

Conclusion:

For elderly patients with severe acute cholangitis, enteral nutrition with ENBD can effectively improve the nutritional status, reduce inflammatory reaction, the impact on liver function, and hospital costs, and shorten the hospitalization time, which is suitable for further clinical application.

Full text: Available Index: WPRIM (Western Pacific) Language: Chinese Journal: Chinese Journal of Digestive Endoscopy Year: 2021 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Language: Chinese Journal: Chinese Journal of Digestive Endoscopy Year: 2021 Type: Article