Parenteral Nutrition and Enteral Nutrition Combined with The Experience of Treatment of Severe Acute Pancreatitis with 200 cases Report_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 XIALong ,  HUWen-xiu ,  OUYANGXiao-hui

Department of Biliary and Pancreatic Surgery, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, Inner Mongolia Autonomous Region, China;

Corresponding author：

HUWen-xiu, Email: 574752493@qq.com; OUYANGXiao-hui, Email: oyXh1961@sina.com

Keywords：

Parental nutrition; Enteral nutrition; Severe acute pancreatitis

DOI：

10.7507/1007-9424.20160116

Video：

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Objective To summary the effect of parenteral nutrition combined with enteral nutrition on patients with severe acute pancreatitis. Methods The clinical data of 200 patients with severe acute pancreatitis admitted in our hospital in recent 10 years were retrospectively analyzed. Of which 88 cases were treated by traditional nutritional support therapy (traditional nutrition group), the rest of 112 cases of patients with early parenteral nutrition to later period gradually combined with enteral nutrition comprehensive nutritional support strategy (comprehensive nutrition group). Results The APACHEⅡscores and serum level of C-reactive protein (CRP) of patients in comprehensive nutrition group were significantly lower than patients in traditional nutrition group (P < 0.05), while the serum albumin level was significantly higher than that of traditional nutrition group (P < 0.05). In the incidence of complications and mortality, the average length of stay and total cost of comprehensive nutrition group were significantly lower than patients with traditional nutrition group (P < 0.05), the cure rate was significantly higher than that of traditional nutrition group (P < 0.05). Conclusion The combination of parenteral nutrition and enteral nutrition of nutrition support model not only can shorten the duration of symptoms but also alleviate the burden of patients and reduce complications and mortality.

Citation： XIALong, HUWen-xiu, OUYANGXiao-hui. Parenteral Nutrition and Enteral Nutrition Combined with The Experience of Treatment of Severe Acute Pancreatitis with 200 cases Report. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(4): 439-444. doi: 10.7507/1007-9424.20160116 Copy

1.	黄志强.急性坏死性胰腺炎外科医生的困惑何在?中华外科杂志, 2001, 39(4):327-328.
2.	Wu XM, Liao YW, Wang HY, et al. When to initialize enteral nutrition in patients with severe acute pancreatitis? A retrospective review in a single institution experience (2003-2013). Pancreas, 2015, 44(3):507-511.
3.	Baron TH. Managing severe acute pancreatitis. Clev Clin J Med, 2013, 80(6):354-359.
4.	McClave SA. Nutrition support in acute pancreatitis. Gastroenterol Clin N, 2007, 36(1):65-74.
5.	Zhang SY, Liang ZY, Yu WQ, et al. Early enteral nutrition with polymeric feeds was associated with chylous ascitesin patients with severe acute pancreatitis. Pancreas, 2014, 43(4):553-558.
6.	Yong L, Lu QP, Liu SH, et al. Efficacy of glutamine-enriched nutrition support for patients with severe acute pancreatitis:a meta-analysis. JPEN J Parenter Enteral Nutr, 2016, 40(1):83-94.
7.	Vieira JP, Araujo GF, Azevedo JR, et al. Parenteral nutrition versus enteral nutrition in severe acute pancreatitis. Acta Cir Bras, 2010, 25(5):449-454.
8.	中华医学会外科学会胰腺学组.急性胰腺炎的临床诊断及分级标准(1996年第二次方案).中华外科杂志, 1997, 35(12):773-775.
9.	张圣道. 2004重症急性胰腺炎诊治指南(征求意见稿)——2000重症急性胰腺炎诊治草案修订.中华医学会第10届全国胰腺外科学术研讨会论文汇编. 2004:6-9.
10.	Pezzilli R, Zerbi A, Campra D, et al. Consensus guidelines on severe acute pancreatitis. Dig Liver Dis, 2015, 47(7):532-543.
11.	Singh A, Chen M, Li T, et al. Parenteral nutrition combined with enteral nutrition for severe acute pancreatitis. ISRN Gastroenterology, 2012, 2012:1-7.
12.	中华医学会重症医学分会.中国重症加强治疗病房危重患者营养支持指导意见(2006).中华外科杂志, 2006, 44(17):1167-1177.
13.	陈小燕, 李兆申.急性胰腺炎患者脂肪乳的临床应用.世界华人消化杂志, 2005, 13(7):877-879.
14.	Bordejé Laguna L, Lorencio Cárdenas C, Acosta Escribano J, et al. Guidelines for specialized nutritional and metabolic support in the critically ill-patient. Update. Consensus of the Spanish Society of Intensive Care Medicineand Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE):severe acute pancreatitis. Med Intensiva, 2011, 35 Suppl 1:33-37.
15.	Malledant Y, Malbrain ML, Reuter DA. What's new in the management of severe acute pancreatitis? Intensive Care Med, 2015, 41(11):1957-1960.
16.	伍静, 孙秋, 虹杨华.不同血糖控制方案对重症胰腺炎患者血糖变异性的影响.中华医学杂志, 2015, 95(19):1496-1500.
17.	Spanier BW, Bruno MJ, Mathus-Vliegen EM. Enteral nutrition and acute pancreatitis:a review. Gastroenterol Res Pract, 2011, 2011. pii:857949.
18.	武彦荣, 尹晶瑜, 范锦辉.早期空肠营养在重症急性胰腺炎中的应用.中国综合临床, 2006, 17(1):49-50.
19.	Yi F, Ge L, Zhao J, et al. Meta-analysis:total parenteral nutrition versus total enteral nutrition in predicted severe acute pancreatitis. Internal Med, 2012, 51(6):523-530.
20.	Zavyalov T, Khotsyna Y, Tenner S. The role of antibiotics in the management of patients with acute necrotizing pancreatitis. Curr Infect Dis Rep, 2010, 12(1):13-18.
21.	Ukai T, Shikata S, Inoue M, et al. Early prophylactic antibiotics administration for acute necrotizing pancreatitis:a meta-analysis of randomized controlled trials. J Hepatobiliary Pancreat Sci, 2015, 22(4):316-321.
22.	Nicholson LJ. Acute pancreatitis:should we use antibiotics? Curr Gastroenterol Rep, 2011, 13(4):336-343.
23.	Mangiante G, Rodella L, Cerofolini A, et al. Severe necrotic and septic pancreatitis. Indications to endoscopic, surgical, and nutritional therapy. G Chir, 2013, 34(9-10):284-287.
24.	Petrov MS. Moving beyond the 'pancreatic rest' in severe and critical acute pan creatitis. Crit Care, 2013, 17(4):161.
25.	Rosendahl J. Early or late enteral nutrition in severe acute pancreatitis? Z Gastroenterol, 2015, 53(3):244-245.
26.	Sun JK, Mu XW, Li WQ, et al. Effects of early enteral nutrition on immune function of severe acute pancreatitis patients. World J Gastroenterol. 2013, 19(6):917-922.
27.	尚占民, 王宝恩, 张淑文.急生重症胰腺炎大鼠粘膜内pH及氧代谢的改变.中国危重病急救医学, 2001, 13(4):226-228.
28.	Piciucchi M, Merola E, Marignani M, et al. Nasogastric or nasointestinal feeding in severe acute pancreatitis. World J Gastroenterol, 2010, 16(29):3692-3696.
29.	Chang YS, Fu HQ, Xiao YM, et al. Nasogastric or nasojejunal feeding in predicted severe acute pancreatitis:a meta-analysis. Crit Care, 2013, 17(3):R118.
30.	Han T, Li XL, Cai DL, et al. Effects of glutamine-supplemented enteral or parenteral nutrition on apoptosis of intestinal mucosal cells in rats with severe acute pancreatitis. Eur Rev Med Pharmacol Sci, 2013, 17(11):1529-1535.
31.	Nally DM, Kelly EG, Clarke M, et al. Nasogastric nutrition is efficacious in severe acute pancreatitis:a systematic review and meta-analysis. Br J Nutr, 2014, 112(11):1769-1778.
32.	Petrov MS, Correia MI, Windsor JA. Nasogastric tube feeding in predicted severe acute pancreatitis. A systematic review of the literature to determine safety and tolerance. JOP, 2008, 9(4):440-448.
33.	Oláh A, Romics L Jr. Enteral nutrition in acute pancreatitis:A review of the current evidence. World J Gastroenterol, 2014, 20(43):16123-16131.
34.	Cote GA. Early enteral feeding does not improve outcomes in patients with predicted severe acute pancreatitis. Gastroenterology, 2015, 148(7):1476-1478.
35.	Li J, Yu T, Chen G, et al. Enteral nutrition within 48 hours of admission improves clinical outcomes of acute pancreatitis by reducing complications:a meta-analysis. PLoS ONE, 2013, 8(6):e64926.
36.	Li X, Ma F, Jia K. Early enteral nutrition within 24 hours or between 24 and 72 hours for acute pancreatitis:evidence based on 12 RCTs. Med Sci Monit, 2014, 20:2327-2335.
37.	Petrov MS, Whelan K. Comparison of complications attributable to enteral and parenteral nutrition in predicted severe acute pancreatitis:a systematic review and meta-analysis. Br J Nutr, 2010, 103(9):1287-1295.
38.	Spain DA, McClave SA, Sexton LK, et al. Infusion protocol improves delivery of enteral tube feeding in the critical careunit. JPEN J Parenter Enteral Nutr, 1999, 23(5):288-292.
39.	Agilli M, Fidan G. The potential role of two appetite hormones in the early detection of pancreaticnecrosis and severe acute pancreatitis:A biochemical aspect. Int J Surg, 2015, 18:69-70.
40.	曾超, 唐勇.重症胰腺炎营养支持治疗的临床研究.重庆医学, 2010, 39(17):2332-2333.
41.	耿小平, 孙昀.急性重症胰腺炎继发感染的诊断与治疗.肝胆外科杂志, 2008, 16(6):415-419.
42.	Shen X, Tong Z, Li W, et al. Infected retroperitoneal pelvic necrosis in severe acute pancreatitis:how can we manage it? Eur J Gastroenterol Hepatol, 2015, 27(4):449-454.
43.	Singh A, Chen M, Li T, et al. Parenteral nutrition combined with enteral nutrition for severe acute pancreatitis. ISRN Gastroenterol, 2012, 2012:791383.

1. 黄志强.急性坏死性胰腺炎外科医生的困惑何在?中华外科杂志, 2001, 39(4):327-328.
2. Wu XM, Liao YW, Wang HY, et al. When to initialize enteral nutrition in patients with severe acute pancreatitis? A retrospective review in a single institution experience (2003-2013). Pancreas, 2015, 44(3):507-511.
3. Baron TH. Managing severe acute pancreatitis. Clev Clin J Med, 2013, 80(6):354-359.
4. McClave SA. Nutrition support in acute pancreatitis. Gastroenterol Clin N, 2007, 36(1):65-74.
5. Zhang SY, Liang ZY, Yu WQ, et al. Early enteral nutrition with polymeric feeds was associated with chylous ascitesin patients with severe acute pancreatitis. Pancreas, 2014, 43(4):553-558.
6. Yong L, Lu QP, Liu SH, et al. Efficacy of glutamine-enriched nutrition support for patients with severe acute pancreatitis:a meta-analysis. JPEN J Parenter Enteral Nutr, 2016, 40(1):83-94.
7. Vieira JP, Araujo GF, Azevedo JR, et al. Parenteral nutrition versus enteral nutrition in severe acute pancreatitis. Acta Cir Bras, 2010, 25(5):449-454.
8. 中华医学会外科学会胰腺学组.急性胰腺炎的临床诊断及分级标准(1996年第二次方案).中华外科杂志, 1997, 35(12):773-775.
9. 张圣道. 2004重症急性胰腺炎诊治指南(征求意见稿)——2000重症急性胰腺炎诊治草案修订.中华医学会第10届全国胰腺外科学术研讨会论文汇编. 2004:6-9.
10. Pezzilli R, Zerbi A, Campra D, et al. Consensus guidelines on severe acute pancreatitis. Dig Liver Dis, 2015, 47(7):532-543.
11. Singh A, Chen M, Li T, et al. Parenteral nutrition combined with enteral nutrition for severe acute pancreatitis. ISRN Gastroenterology, 2012, 2012:1-7.
12. 中华医学会重症医学分会.中国重症加强治疗病房危重患者营养支持指导意见(2006).中华外科杂志, 2006, 44(17):1167-1177.
13. 陈小燕, 李兆申.急性胰腺炎患者脂肪乳的临床应用.世界华人消化杂志, 2005, 13(7):877-879.
14. Bordejé Laguna L, Lorencio Cárdenas C, Acosta Escribano J, et al. Guidelines for specialized nutritional and metabolic support in the critically ill-patient. Update. Consensus of the Spanish Society of Intensive Care Medicineand Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE):severe acute pancreatitis. Med Intensiva, 2011, 35 Suppl 1:33-37.
15. Malledant Y, Malbrain ML, Reuter DA. What's new in the management of severe acute pancreatitis? Intensive Care Med, 2015, 41(11):1957-1960.
16. 伍静, 孙秋, 虹杨华.不同血糖控制方案对重症胰腺炎患者血糖变异性的影响.中华医学杂志, 2015, 95(19):1496-1500.
17. Spanier BW, Bruno MJ, Mathus-Vliegen EM. Enteral nutrition and acute pancreatitis:a review. Gastroenterol Res Pract, 2011, 2011. pii:857949.
18. 武彦荣, 尹晶瑜, 范锦辉.早期空肠营养在重症急性胰腺炎中的应用.中国综合临床, 2006, 17(1):49-50.
19. Yi F, Ge L, Zhao J, et al. Meta-analysis:total parenteral nutrition versus total enteral nutrition in predicted severe acute pancreatitis. Internal Med, 2012, 51(6):523-530.
20. Zavyalov T, Khotsyna Y, Tenner S. The role of antibiotics in the management of patients with acute necrotizing pancreatitis. Curr Infect Dis Rep, 2010, 12(1):13-18.
21. Ukai T, Shikata S, Inoue M, et al. Early prophylactic antibiotics administration for acute necrotizing pancreatitis:a meta-analysis of randomized controlled trials. J Hepatobiliary Pancreat Sci, 2015, 22(4):316-321.
22. Nicholson LJ. Acute pancreatitis:should we use antibiotics? Curr Gastroenterol Rep, 2011, 13(4):336-343.
23. Mangiante G, Rodella L, Cerofolini A, et al. Severe necrotic and septic pancreatitis. Indications to endoscopic, surgical, and nutritional therapy. G Chir, 2013, 34(9-10):284-287.
24. Petrov MS. Moving beyond the 'pancreatic rest' in severe and critical acute pan creatitis. Crit Care, 2013, 17(4):161.
25. Rosendahl J. Early or late enteral nutrition in severe acute pancreatitis? Z Gastroenterol, 2015, 53(3):244-245.
26. Sun JK, Mu XW, Li WQ, et al. Effects of early enteral nutrition on immune function of severe acute pancreatitis patients. World J Gastroenterol. 2013, 19(6):917-922.
27. 尚占民, 王宝恩, 张淑文.急生重症胰腺炎大鼠粘膜内pH及氧代谢的改变.中国危重病急救医学, 2001, 13(4):226-228.
28. Piciucchi M, Merola E, Marignani M, et al. Nasogastric or nasointestinal feeding in severe acute pancreatitis. World J Gastroenterol, 2010, 16(29):3692-3696.
29. Chang YS, Fu HQ, Xiao YM, et al. Nasogastric or nasojejunal feeding in predicted severe acute pancreatitis:a meta-analysis. Crit Care, 2013, 17(3):R118.
30. Han T, Li XL, Cai DL, et al. Effects of glutamine-supplemented enteral or parenteral nutrition on apoptosis of intestinal mucosal cells in rats with severe acute pancreatitis. Eur Rev Med Pharmacol Sci, 2013, 17(11):1529-1535.
31. Nally DM, Kelly EG, Clarke M, et al. Nasogastric nutrition is efficacious in severe acute pancreatitis:a systematic review and meta-analysis. Br J Nutr, 2014, 112(11):1769-1778.
32. Petrov MS, Correia MI, Windsor JA. Nasogastric tube feeding in predicted severe acute pancreatitis. A systematic review of the literature to determine safety and tolerance. JOP, 2008, 9(4):440-448.
33. Oláh A, Romics L Jr. Enteral nutrition in acute pancreatitis:A review of the current evidence. World J Gastroenterol, 2014, 20(43):16123-16131.
34. Cote GA. Early enteral feeding does not improve outcomes in patients with predicted severe acute pancreatitis. Gastroenterology, 2015, 148(7):1476-1478.
35. Li J, Yu T, Chen G, et al. Enteral nutrition within 48 hours of admission improves clinical outcomes of acute pancreatitis by reducing complications:a meta-analysis. PLoS ONE, 2013, 8(6):e64926.
36. Li X, Ma F, Jia K. Early enteral nutrition within 24 hours or between 24 and 72 hours for acute pancreatitis:evidence based on 12 RCTs. Med Sci Monit, 2014, 20:2327-2335.
37. Petrov MS, Whelan K. Comparison of complications attributable to enteral and parenteral nutrition in predicted severe acute pancreatitis:a systematic review and meta-analysis. Br J Nutr, 2010, 103(9):1287-1295.
38. Spain DA, McClave SA, Sexton LK, et al. Infusion protocol improves delivery of enteral tube feeding in the critical careunit. JPEN J Parenter Enteral Nutr, 1999, 23(5):288-292.
39. Agilli M, Fidan G. The potential role of two appetite hormones in the early detection of pancreaticnecrosis and severe acute pancreatitis:A biochemical aspect. Int J Surg, 2015, 18:69-70.
40. 曾超, 唐勇.重症胰腺炎营养支持治疗的临床研究.重庆医学, 2010, 39(17):2332-2333.
41. 耿小平, 孙昀.急性重症胰腺炎继发感染的诊断与治疗.肝胆外科杂志, 2008, 16(6):415-419.
42. Shen X, Tong Z, Li W, et al. Infected retroperitoneal pelvic necrosis in severe acute pancreatitis:how can we manage it? Eur J Gastroenterol Hepatol, 2015, 27(4):449-454.
43. Singh A, Chen M, Li T, et al. Parenteral nutrition combined with enteral nutrition for severe acute pancreatitis. ISRN Gastroenterol, 2012, 2012:791383.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Parenteral Nutrition and Enteral Nutrition Combined with The Experience of Treatment of Severe Acute Pancreatitis with 200 cases Report

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