Effect of early enteral nutrition support on inflammatory reaction and nutritional status in patients with severe acute pancreatitis

Objective To study the effect of early enteral nutrition support on inflammatory reaction and nutritional status in patients with severe acute pancreatitis(SAP). Methods From August 2011 to August 2016, 182 patients with SAP in Yuncheng Central Hospital were selected.The patients were divided into study group and control group according to random number table method, with 91 cases in each group.The two groups were given routine treatment of SAP, the control group was given parenteral nutrition support, the study group was given early enteral nutrition support, the two groups were given continuous nutritional support for 2 weeks.The acute physiology and chronic health score Ⅱ(APACHE Ⅱ), intestinal function recovery time, systemic inflammatory response syndrome(SIRS) improvement time and hospital stay were compared between the two groups.The levels of serum inflammatory cytokines, nutritional status, the incidence of multiple organ failure(MODS) and mortality were compared before and after treatment. Results The APACHE Ⅱ, intestinal function recovery time, SIRS improvement time and hospital stay in the study group after treatment were (6.14±1.20)points, (3.48±0.16)d, (4.31±2.02)d, (23.38±10.2)d, which were significantly lower than those in the control group[(7.88±2.04)points, (6.21±1.33)d, (8.77±2.11)d, (29.46±11.31)d](t=4.595, 19.441, 14.601, 18.797, all P<0.05). The serum levels of interleukin-6(IL-6), interleukin-8(IL-8) and tumor necrosis factor-α(TNF-α) in the study group after treatment were (11.20±3.68)ng/L, (94.33±48.19)ng/L, (103.55±55.87)ng/L, which were significantly lower than those in the control group[(22.47±9.84)ng/L, (240.72±78.85)ng/L, (245.62±105.48)ng/L](t=15.233, 85.112, 73.354, all P<0.05). The serum levels of IL-6, IL-8 and TNF-α in two groups were significantly lower than before treatment(t=10.753, 63.128, 55.372, 24.725, 102.337, 88.567, all P<0.05). The serum levels of albumin, prealbumin in the study group after treatment were (41.24±6.25)g/L, (285.21±91.34)mg/L, which were significantly higher than those in the control group[(37.15±5.71)g/L, (233.87±83.56)mg/L](t=8.609, 58.956, all P<0.05). The serum albumin and prealbumin in the two groups were significantly higher than those before treatment(t=5.773, 78.521, 12.821, 92.420, all P<0.05). The incidence rate of complications and mortality in the study group were 39.56% and 14.29%, which were significantly lower than those in the control group(60.44%, 30.77%), and the difference was statistically significant(χ2=7.934, 7.084, all P<0.05). Conclusion The effect of early enteral nutrition support in patients with SAP is obvious, can effectively reduce the inflammatory response of patients and improve nutritional status, has good safety, which is worthy of clinical application. Key words: Pancreatitis; Acute disease; Intensive care; Enteral nutrition; Parenteral nutrition; Chemokines; Nutritional status; Influence