Comparative study of enteral ecoimmunonutrition and immune enhanced enteral nutrition in the treatment of severe acute pancreatitis

doi:10.3877/cma.j.issn.1674-0793.2017.04.004

Abstract

Abstract:

Objective

To compare the effects of enteral immune, enteral ecoimmunonutrition (EE), immune enhanced enteral nutrition (IE) on the efficacy, stool flora, prognosis and nutritional status in patients with severe acute pancreatitis (SAP).

Methods

From June 2015 to December 2016, ninety six patients with SAP were randomly divided into EE group and IE group, with 48 cases in each group. Meanwhile, 24 patients with SAP who were unable to undergo early enteral nutrition support due to severe abdominal distension during the same period were selected as control group. Comparison indexes of the three groups before and after intervention for 1 week and 2 weeks included efficacy indicators (serum albumin, amylase, white blood cell count), nutritional status index (albumin, transferrin) and the pathogenesis of 7-10 d after the fecal flora changes (dysbacteriosis incidence). After 2 weeks, side reactions, complications and adverse prognosis were observed and analyzed.

Results

(1) 1 week and 2 weeks after intervention, serum albumin, amylase, WBC level of the three groups were lower than that before the intervention. White blood cell count, AMS recovery time in EE group were lower than those in the IE group, the two groups both lower than that in the control group. At the first week, the levels of albumin in EE and IE groups were lower than those in the control group, the difference was statistically significant (P<0.05). (2) The levels of prealbumin in EE and IE groups were higher than those in the control group at 1-2 weeks after intervention, but there was no significant difference between the two groups. There was no significant difference in TRF between EE and IE group at 1-2 weeks after intervention, and the TRF at the first week was higher than that in the control group (P<0.05). (3) 7-10 days after the intervention, the incidence of bacterial flora in stool smear of EE group was lower than that in IE group and control group, the difference was statistically significant (χ²=5.315, 5.679, P=0.021, 0.017). (4) The incidence of complications and the total incidence of severe complications in EE and IE group were not statistically significant, and the total incidence of serious complications was lower than that of the control group (χ²=12.255, 10.867, P=0.000, 0.001), and no deaths or adverse reactions occurred in the three groups.

Conclusion

For patients with SAP, it is suggested that early enteral nutrition therapy, especially enteral immune micronutrition therapy, can help improve the microenvironment of the intestinal tract and reduce the risk of complications.

Key words: Pancreatitis, Enteral nutrition, Treatment outcome, Enteral ecoimmunonutrition, Immune enhanced

Xiaohua Xie, Li Zhang. Comparative study of enteral ecoimmunonutrition and immune enhanced enteral nutrition in the treatment of severe acute pancreatitis[J]. Chinese Archives of General Surgery(Electronic Edition), 2017, 11(04): 231-235.

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References 18

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组别	血清白蛋白（g/L）			淀粉酶（U/L）			白细胞计数（×10⁹/L）
组别	干预前	第1周	第2周	干预前	第1周	第2周	干预前	第1周	第2周
对照组（n=24）	28.5±4.6	35.6±5.6^a	43.6±5.3^a	1174.3±405.2	735.6±12.4^a	225.3±43.9^a	26.4±3.5	22.4±3.4^a	17.1±4.5^a
EE组（n=48）	28.6±4.5	43.9±6.1^ab	44.8±5.5^a	1293.0±566.3	638.9±153.2^ab	172.3±53.6^ab	26.3±3.1	15.6±3.3^abc	11.0±2.6^abc
IE组（n=48）	28.5±4.7	43.6±6.0^ab	44.2±5.6^a	1206.7±437.5	640.1±154.1^ab	180.1±55.6^ab	25.9±3.2	18.4±2.3^ab	14.3±3.2^ab

组别	血清白蛋白（g/L）			淀粉酶（U/L）			白细胞计数（×10⁹/L）
组别	干预前	第1周	第2周	干预前	第1周	第2周	干预前	第1周	第2周
对照组（n=24）	28.5±4.6	35.6±5.6^a	43.6±5.3^a	1174.3±405.2	735.6±12.4^a	225.3±43.9^a	26.4±3.5	22.4±3.4^a	17.1±4.5^a
EE组（n=48）	28.6±4.5	43.9±6.1^ab	44.8±5.5^a	1293.0±566.3	638.9±153.2^ab	172.3±53.6^ab	26.3±3.1	15.6±3.3^abc	11.0±2.6^abc
IE组（n=48）	28.5±4.7	43.6±6.0^ab	44.2±5.6^a	1206.7±437.5	640.1±154.1^ab	180.1±55.6^ab	25.9±3.2	18.4±2.3^ab	14.3±3.2^ab

组别	前白蛋白（mg/L）			转铁蛋白（g/L）
组别	干预前	第1周	第2周	干预前	第1周	第2周
对照组（n=24）	205.7±21.0	240.3±13.5	251.5±12.3	1.4±0.3	1.4±0.5	1.9±0.3
EE组（n =48）	204.8±22.5	286.5±12.1^{a b}	293.7±14.5^{a b}	1.4±0.3	1.9±0.5 ^{a b}	2.0±0.4^a
IE组（n =48）	205.1±21.5	283.4±15.6^{a b}	295.3±12.1^{a b}	1.4±0.5	1.9±0.6 ^{a b}	2.0±0.4^a

组别	前白蛋白（mg/L）			转铁蛋白（g/L）
组别	干预前	第1周	第2周	干预前	第1周	第2周
对照组（n=24）	205.7±21.0	240.3±13.5	251.5±12.3	1.4±0.3	1.4±0.5	1.9±0.3
EE组（n =48）	204.8±22.5	286.5±12.1^{a b}	293.7±14.5^{a b}	1.4±0.3	1.9±0.5 ^{a b}	2.0±0.4^a
IE组（n =48）	205.1±21.5	283.4±15.6^{a b}	295.3±12.1^{a b}	1.4±0.5	1.9±0.6 ^{a b}	2.0±0.4^a

组别	肺炎	脑病	弥漫性血管内凝血	其他	合计
对照组（n=24）	3（12.50）	3（12.50）	6（25.00）	3（12.50）	15（62.50）
EE组（n=48）	3（6.25）	2（4.17）	2（4.17）	3（6.25）	10（20.83）
IE组（n =48）	4（8.33）	2（4.17）	2（4.17）	3（6.25）	11（22.92）
χ²₁，χ²₂，χ²₃值	0.818,0.316,0.154	1.719,1.719,0.261	7.031,7.031,0.261	0.818,0.818,0.178	12.255,10.867,0.061
P₁，P₂，P₃值	0.316, 0.574,0.695	0.190, 0.190,0.610	0.008,0.008,0.610	0.316, 0.316,0.673	0.000,0.001,0.805

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