Objective To investigate the effect of early enteral nutrition (EN) at different time points on the clinical outcomes of severe acute pancreatitis (SAP). Methods A total of 174 patients with SAP admitted from January 2013 to December 2016 were studied retrospectively. The cases after screening were divided into group A (<5 d) and group B（5-14 d）in the final analysis according to the initial time of EN. They were analyzed for change in acute physiology and chronic health evaluation (APAHCE) Ⅱ score and sequential organ failure assessment (SOFA) score, length of hospital stay, operative rate, mortality and complications rate including acute kidney injury (AKI), acute respiratory distress syndrome, sepsis, abdominal compartment syndrome and pancreatic pseudocyst. Results A total of 98 cases were included finally. Fifty-one cases were in group A and 47 in group B. On the day of admission, there was no significant difference in APACHE Ⅱ score and SOFA score between 2 groups (P>0.05). APACHE Ⅱ scores and SOFA scores of cases in 2 groups were significantly lower on day 14 and 28 compared to those on admission day (P<0.05) and those scores on day 14 and 28 in group A were lower than in group B. On day 28, the reduction of SOFA score was significantly greater in group A than that in group B (P<0.05). The significant lower rate of acute kidney injury (AKI) in group A was found when compared with that in group B (P<0.05), but no difference was present in the rates of other complication including acute respiratory distress syndrome, sepsis, abdominal compartment syndrome and pancreatic pseudocyst(P>0.05). The cases in group A had significantly lower operative rate and lower 60-day mortality compared with those in group B (P<0.05). However, the difference in length of hospital stay and 28-day mortality was not seen between 2 groups (P>0.05). Conclusions The different time points patients with SAP initiated early EN within 5 days of admission had lower rate of AKI, lower operative rate and lower 60-day mortality compared with those initiated EN after 5 days. Early initiation of EN within 5 days also significantly reduced APACHE Ⅱ score and SOFA score, in which the decrease of SOFA score was more prominent. It recommends to start EN early in patients with SAP.
ZHOU Lei, CHEN Ying, YAO Yi, ZHAO Bing, YANG Zhitao, CHE Zaiqian, FEI Jian, SHENG Huiqiu, MAO Enqiang, CHEN Erzhen
. Retrospective study of timing of early enteral nutrition on prognosis in patients with severe acute pancreatitis[J]. Journal of Surgery Concepts & Practice, 2019
, 24(01)
: 55
-59
.
DOI: 10.16139/j.1007-9610.2019.01.012
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