OBJECTIVE: To observe the therapeutic effect of electroacupuncture (EA) in improving early enteral nutrition tolerance in patients with acute pancreatitis (AP) under the concept of accelerated rehabilitation, and to explore the related mechanism based on the changes in autonomic nerve characteristics. METHODS: A total of 42 patients with AP were randomized into an observation group (21 cases, 1 case dropped out) and a control group (21 cases, 1 case dropped out). The control group received standard basic treatment for AP. On the basis of the treatment in the control group, EA was applied in the observation group, bilateral Zusanli (ST36), Yixian point (Extra), Tianshu (ST25), Neiguan (PC6) and Zhongwan (CV12) were selected as the main points, and the supplementary points were selected according to syndrome differentiation. Ipsilateral Zusanli (ST36) and Yixian point (Extra) were connected to EA, using discontinuous wave, in frequency of 2 Hz, 30 min a time, once a day for 6 continuous days. The enteral nutrition tolerance score was observed before treatment and after 3 and 5 days of treatment; the visual analogue scale (VAS) score for abdominal pain was observed before treatment and after 3 days of treatment; the time of reaching the feeding goal and hospital stay was recorded; the levels of C-reactive protein (CRP) and amylase were measured before treatment and after 5 days of treatment; the heart rate variability (HRV) indexes (standard deviation of NN intervals [SDNN], average standard deviation of NN intervals [SDANN], root mean square of successive NN interval differences [rMSSD], low frequency [LF] and high frequency [HF], ratio of low frequency to high frequency [LF/HF]) were monitored in the two groups. RESULTS: After 3 and 5 days of treatment, the enteral nutrition tolerance scores were decreased compared with those before treatment in both groups (P<0.01), the reductions in the observation group were larger than those in the control group (P<0.01). After 3 days of treatment, the VAS scores for abdominal pain were decreased compared with those before treatment in both groups (P<0.01), the reduction in the observation group was larger than that in the control group (P<0.01). The time of reaching the feeding goal and hospital stay in the observation group was shorter than that in the control group (P<0.05). After 5 days of treatment, the CRP and amylase levels were decreased compared with those before treatment in both groups (P<0.01), the reduction of CRP level in the observation group was larger than that in the control group (P<0.01). In the observation group, SDNN, SDANN and LF/HF were lower than those in the control group (P<0.05, P<0.01), while rMSSD was higher than that in the control group (P<0.01). SDNN, SDANN and LF/HF were positively correlated with the enteral nutrition tolerance scores after 3 and 5 days of treatment (P<0.05), while rMSSD was negatively correlated with the enteral nutrition tolerance scores after 3 and 5 days of treatment (P<0.01). CONCLUSION Electroacupuncture can improve enteral nutrition tolerance in patients with AP by regulating autonomic nervous function, alleviating the inflammation, promoting accelerated recovery, and reducing the length of hospital stay.
Humans ; Electroacupuncture ; Male ; Female ; Enteral Nutrition ; Middle Aged ; Adult ; Pancreatitis/physiopathology* ; Aged ; Acupuncture Points ; Young Adult ; Acute Disease/therapy* ; Autonomic Pathways/physiopathology*

Objective: Intra-abdominal hypertension(IAH),commonly seen in various critical surgical cases,may lead to body ischemia and reperfusion damage and result in serious inflammatory response.Previous studies were concentrated mostly on the risk of IAH,but less on IAH-induced reperfusion damage.The purpose of this study was to investigate the impact of IAH on the intestine.Methods: A total of 120 Sprague-Daley rats were divided into an abdominal compartment syndrome(ACS) group,with intra-abdominal pressure(IAP) increased to 20 mmHg,an ACS/decompression(ACS/DE) group,with increased IAP followed by decompression,and two control groups,with IAP unchanged.Malondialdehyde(MDA),myeloperoxidase(MPO),glutathione(GSH) and glutathione peroxidase(GSH-Px) enzyme of the intestine were measured.Additionally,ileal tissues were taken for histopathological examinations and apoptosis detection;the liver,spleen,and mesenteric lymph nodes were obtained for microbiological analysis.Results: In the presence of IAH,MDA and MPO were increased,while GSH and GSH-Px were decreased.Microbiological analysis suggested bacterial translocation across the gut.Morphological examinations indicated that Chiu's score and apoptotic index in the ACS/DE group were the highest in the four groups.Conclusion: Oxidative stress plays an important role in the intestinal damage and bacterial translocation in abdominal compartment syndrome.Additionally,the influence of oxygen free radicals occurs mainly during the reperfusion rather than the IAH period.