Effect of early continuous enteral nutrition combined with interstinal mucosal protective agents on gut barrier in patients with severe acute pancreatitis:A multicenter prospective randomized controlled trial
- VernacularTitle:持续早期肠内营养联合肠黏膜保护对重症急性胰腺炎肠屏障功能影响的多中心随机对照临床试验
- Author:
Xiaoxi HUANG
;
Xingpeng WANG
;
Kai WU
;
Chunfang XU
;
Weichang CHEN
;
Yadong WANG
;
Jiayi ZHU
;
Lei GONG
;
Ming XU
;
Xiaobin PENG
- Publication Type:Journal Article
- Keywords:
Pancreatitis,acute necrotizing;
Intestinal mucosa;
Enteral nutrition;
Parenteral nutrition
- From:
Chinese Journal of Digestion
2008;28(4):225-229
- CountryChina
- Language:Chinese
-
Abstract:
Objective To assess the effect of continuous early enteral nutrition(EEN)combined with intestinal mucosal protective agents on gut barrier function in patients with severe acute pancreatitis.Methods A total of 79 patients with severe acute pancreatitis selected from four centers between May 2004 to June 2006 were enrolled and divided into EEN combined with intestinal mucosal protective agents group(combined group,n=39)and total parenteral nutrition(TPN)group(n=40).The patients were received either EEN or TPN when homeostasis were achieved within 72 hours after onset.The patients in combined group were administered pepti-2000 variant combined with glutamine,arginine and intestinal mucosal protective agents.The patients in TPN group were administered through a central vein.APACHE-Ⅱ score was recorded every week;The concentration of serum amylase,plasmic diamine oxi dase(DAO)and endotoxin were mesured on day 1,7,14 and 21 as well as urinary excretion of lactulose (L)and mannitol(M).Complications,lenth and charges of hospital stay were recorded.Results There was no death in both groups.The APACHE-Ⅱ score decreased on day 7,but lower in combined group (6.00±1.60)than that in TPN group(7.08±2.34)(P＜0.05).On day 7,14 and 21,the concentrations of endotoxin in combined group was(39.30±15.82),(22.64±14.31),(14.81±10.93)Eu/L,respectively,urinary L/M ratio was 0.28±0.25,0.21±0.18 and 0.08±0.04,respectively,IFABP-c was 15.62±5.26),(5.46±1.18)and(3.26±0.94)pg/ml,respectively.All of these parameters were significantly lower than those in TPN group(P＜0.05).The infectious rates including pancreatic,peritoneal and respiratory infection in TPN group were much higher than that in combined group(26.47% vs 3.44%,P＜0.01).The composition of flora fecal remained unchange in combined group rather than TPN group.The mean hospital stay was shorter in combined group[(20.0±5.7)days]compared to TPN groups[(34.5±12.9)days].The charges were also significantly lower in combined group,with average cost of RMB 25,900±14,200,while it was 46,800±4,030 in TPN group.Conclusions EEN combined with intestinal mucosal protective agents can improve gut barrier function via reducing the gut permeability,improving the hypoperfusion,maintaining the integrity and gut fecal flora.It might reduce the course and charges of hospital stay.
