Effects of different nutritional support on the intestinal function,C - reactive protein and plasma endotoxin in patients with severe acute pancreatitis / 中国基层医药

ABSTRACT

Objective To investigate the effects of different nutritional support on the intestinal function, C - reactive protein (CRP) and plasma endotoxin (LPS) in patients with severe acute pancreatitis (SAP). Methods From August 2012 to September 2016,112 patients with SAP in Yuncheng Central Hospital were selected and divided into three groups by random number table method. There were complete parenteral nutrition group(TPN group,n =37),early enteral nutrition group(EEN group,n = 37),parenteral and early enteral nutrition group(PN + EEN group, n = 38). The levels of CRP,LPS and tumor necrosis factor - α(TNF - α) in three groups were detected at the first day after admission,the seventh day and the fourteenth day after nutrition support respectively. The levels of D - lactic acid and diamine oxidase (DAO) in the three groups were detected at the first day after admission and the fourteenth day after nutrition support respectively. The occurrence of infection,abdominal distension,diarrhea,multiple organ failure syndrome (MODS),gastrointestinal bleeding among the three groups were compared at the fourteenth day after nutrition support. Results The levels of serum CRP,LPS and TNF - α at the seventh day and fourteenth day after nutrition support in the PN + EEN group[7d:(35. 56 ± 4. 54)mg/ L,(1. 59 ± 0. 58)EU/ L,(48. 56 ± 5. 25) ng/ L; 14d:(8. 68 ± 2. 36) mg/ L,(1. 23 ± 0. 43) EU/ L,(38. 63 ± 4. 82) ng/ L] were significantly lower than those in the TPN group[7d:(60. 86 ± 5. 63)mg/ L,(1. 91 ± 0. 59) EU/ L,(54. 10 ± 4. 02) ng/ L;14d: (28. 38 ± 2. 47) mg/ L, (1. 62 ± 0. 52)EU/ L,(44. 51 ± 4. 58)ng/ L]and the EEN group[7d:(59. 58 ± 5. 25)mg/ L,(1. 89 ± 0. 61)EU/ L, (52. 54 ± 5. 13) ng/ L;14d:(27. 45 ± 2. 13) mg/ L,(1. 58 ± 0. 46) EU/ L,(43. 21 ± 5. 20) ng/ L],the differences were statistically significant (tTPN group = 21. 451,35. 321,2. 369,3. 544,5. 121,5. 413,tEEN group = 21. 212,36. 127, 2. 183,3. 405,3. 320,3. 957,all P < 0. 05). The levels of D - lactic acid and DAO at the fourteenth day after nutrition support in the PN + EEN group[(5. 27 ± 1. 01)mg/ L,(5. 78 ± 1. 94)U/ L]were lower than those in the TPN group [(8. 62 ± 1. 26) mg/ L,(9. 32 ± 2. 04) U/ L] and the EEN group[(8. 43 ± 1. 08) mg/ L,(8. 98 ± 2. 01) U/ L] (tTPN group = 12. 619,12. 999,tEEN group = 7. 649,6. 968,all P < 0. 05). After nutritional support treatment for 14 days, the numbers of abdominal distension and diarrhea,MODS,infection in the PN + EEN group were 4 cases,2 cases and 5 cases,respectively,which were significantly lower than those in the EEN group(11 cases,8 cases,12 cases) and the TPN group(12 cases,9 cases,13 cases),the differences were statistically significant (χ2 = 5. 361,4. 321,4. 964, 3. 973,5. 442,4. 341,all P < 0. 05). Conclusion PN combined with EEN can effectively reduce the levels of CRP, LPS,TNF - α,D - lactic acid and DAO in patients with SAP,and improve the intestinal mucosal barrier function,it has fewer complications,the effect of clinical treatment is better,which is worthy of clinical promotion and application.