Comparative study of sequential nutritional support and parenteral nutrition support in clinical intervention of pediatric acute pancreatitis

doi:10.11958/20231850

Abstract

Abstract:

Objective To compare and analyze the effectiveness of sequential nutritional support and parenteral nutrition support in clinical intervention of pediatric acute pancreatitis. Methods Data of 102 children with acute pancreatitis were retrospectively collected and divided into the parenteral nutrition group (n=51) and the sequential nutrition group (n=51) based on the type of parenteral nutrition support. Changes in nutritional status, immune function indicators and body rehabilitation indicators were compared before and after intervention between two groups. The humoral immune indexes (IgA, IgG and IgM) were detected by immunonephelometry. The body recovery indexes (abdominal distension relief time, oral feeding recovery time, body temperature recovery time, blood and urine amylase recovery time and hospital stay) were compared between the two groups. Results After intervention, levels of serum albumin, total protein and prealbumin were higher in the study group than those in the control group, while levels of blood amylase and urine amylase were lower than those in the control group (P<0.05). After intervention, the CD3⁺, CD4⁺ and CD4⁺/CD8⁺indicators were higher in the study group than those in the control group (P<0.05). After intervention, IgA, IgG and IgM indicators were higher in the study group than those in the control group (P<0.05). The relief time of abdominal distension, recovery time of oral feeding, recovery time of body temperature, recovery time of blood and urine amylase and hospitalization time were all shorter in the study group than those in the control group (P<0.05). Conclusion Sequential nutritional support can effectively improve the nutritional status of children with acute pancreatitis, enhance immune function and promote physical recovery compared to parenteral nutrition support.

Key words: pancreatitis, acute necrotizing, parenteral nutrition, child, sequential nutritional support, immunologic function

CLC Number:

R725.761，R459.3

Figures/Tables 4

References 20

[1]	LEDDER O, DUVOISIN G, LEKAR M, et al. Aarly feeding in acute pancreatitis in children:a randomized controlled trial[J]. Pediatrics, 2020, 146(3):e20201149. doi:10.1542/peds.2020-1149.
[2]	FONSECA SEPÚLVEDA E V, GUERRERO-LOZANO R. Acute pancreatitis and recurrent acute pancreatitis:an exploration of clinical and etiologic factors and outcomes[J]. J Pediatr(Rio J), 2019, 95(6):713-719. doi:10.1016/j.jped.2018.06.011.
[3]	CAI W. Best practice of nutritional support for pediatric acute pancreatitis[J]. World J Pediatr, 2021, 17(5):551. doi:10.1007/s12519-021-00449-6.
[4]	BUKOWSKI J S, DEMBIŃSKI Ł, DZIEKIEWICZ M, et al. Early enteral nutrition in paediatric acute pancreatitis-a review of published studies[J]. Nutrients, 2022, 14(16):3441. doi:10.3390/nu14163441.
[5]	中华医学会消化病学分会胰腺疾病学组, 中华胰腺病杂志编辑委员会, 中华消化杂志编辑委员会. 中国急性胰腺炎诊治指南(2013年,上海)[J]. 中华消化杂志, 2013, 33(4):217-222.
	Pancreatic Disease Group of the Digestive Disease Branch of the Chinese Medical Association, Editorial Committee of the Chinese Journal of Pancreatic Disease, and Editorial Committee of the Chinese Journal of Digestive Diseases. Chinese Guidelines for the Diagnosis and Treatment of Acute Pancreatitis (2013,Shanghai)[J]. Chinese Journal of Digestive Medicine, 2013, 33(4):217-222.
[6]	程炯炯, 李琳琳, 赵浩东, 等. CRRT联合血浆置换救治高脂血症性重症急性胰腺炎患者的疗效分析[J]. 天津医药, 2023, 51(8):855-859.
	CHENG J J, LI L L, ZHAO H D, et al. Curative effect of CRRT combined with plasma exchange in the treatment of hyperlipidemic severe acute pancreatitis[J]. Tianjin Med J, 2023, 51(8):855-859. doi:10.11958/20221994.
[7]	MOSZTBACHER D, FARKAS N, SOLYMÁR M, et al. Restoration of energy level in the early phase of acute pediatric pancreatitis[J]. World J Gastroenterol, 2017, 23(6):957-963. doi:10.3748/wjg.v23.i6.957.
[8]	赵春宁, 刘艳. 序贯肠外肠内营养支持联合胆汁回输在肝内胆管结石术后患儿中的应用效果观察[J]. 贵州医药, 2021, 45(11):1838-1839.
	ZHAO C N, LIU Y. Observation of the application effect of sequential parenteral and enteral nutrition support combined with bile reflux in postoperative patients with intrahepatic bile duct stones[J]. Guizhou Medical Journal, 2021, 45(11):1838-1839. doi:10.3969/j.issn.1000-744X.2021.11.094.
[9]	隆琦, 王金湖, 张婷, 等. 序贯式营养治疗在儿童胰腺肿瘤术后的应用效果[J]. 实用肿瘤杂志, 2021, 36(2):129-134.
	LONG Q, WANG J H, ZHANG T, et al. Effeet of sequential nutritional support on children with pancreatic tumor after operation[J]. Journal of Practical Oncology, 2021, 36(2):129-134.doi:10.13267/j.cnki.syzlzz.2021.027.
[10]	李静, 覃腊云, 欧阳辉, 等. 序贯肠内外营养支持对AECOPD合并呼吸衰竭患儿营养指标、胃肠黏膜功能和免疫功能的影响[J]. 现代生物医学进展, 2022, 22(7):1333-1337.
	LI J, QIN L Y, OUYANG H, et al. The effects of sequential enteral and parenteral nutrition support on nutritional indicators,gastrointestinal mucosal function,and immune function in AECOPD patients with respiratory failure[J]. Modern Biomedical Progress, 2022, 22(7):1333-1337. doi:10.13241/j.cnki.pmb.2022.07.029.
[11]	JABŁOŃSKA B, MROWIEC S. Nutritional support in patients with severe acute pancreatitis-current standards[J]. Nutrients, 2021, 13(5):1498. doi:10.3390/nu13051498.
[12]	JAMES T W, CROCKETT S D. Management of acute pancreatitis in the first 72 hours[J]. Curr Opin Gastroenterol, 2018, 34(5):330-335. doi:10.1097/MOG.0000000000000456.
[13]	FREEMAN A J, MAQBOOL A, BELLIN M D, et al. Medical management of chronic pancreatitis in children:a position paper by the north american society for pediatric gastroenterology,hepatology,and nutrition pancreas committee[J]. J Pediatr Gastroenterol Nutr, 2021, 72(2):324-340. doi:10.1097/MPG.0000000000003001.
[14]	杨艳丽, 杨晓丽. 序贯化营养与肠外营养在小儿急性胰腺炎护理中的应用效果观察[J]. 护理研究, 2022, 36(8):1480-1483.
	YANG Y L, YANG X L. Application effect of sequential nutrition and parenteral nutrition in the nursing of children with acute pancreatitis[J]. Chinese Nursing Research, 2022, 36(8):1480-1483. doi:10.12102/j.issn.1009-6493.2022.08.033.
[15]	GOMES C A, DI SAVERIO S, SARTELLI M, et al. Severe acute pancreatitis:eight fundamental steps revised according to the 'PANCREAS' acronym[J]. Ann R Coll Surg Engl, 2020, 102(8):555-559. doi:10.1308/rcsann.2020.0029.
[16]	RAMANATHAN M, AADAM A A. Nutrition management in acute pancreatitis[J]. Nutr Clin Pract, 2019, 34(Suppl 1):S7-S12. doi:10.1002/ncp.10386.
[17]	何承龙, 昝建宝, 宋康颉, 等. 上消化道穿孔术后早期序贯性肠内营养支持的效果观察[J]. 解放军医学院学报, 2020, 41(9):901-904.
	HE C L, ZAN J B, SONG K J, et al. Effect of early sequential enteral nutrition support on patients with upper digestive tract perforation after surgery[J]. Academic Journal of Chinese PLA Medical School, 2020, 41(9):901-904. doi:10.3969/j.issn.2095-5227.2020.09.013.
[18]	PETROV M S, YADAV D. Global epidemiology and holistic prevention of pancreatitis[J]. Nat Rev Gastroenterol Hepatol, 2019, 16(3):175-184. doi:10.1038/s41575-018-0087-5.
[19]	DIKE C R, ABU-EL-HAIJA M. Nutrition management and pancreatitis in children:new insights[J]. Curr Opin Clin Nutr Metab Care, 2022, 25(5):321-324. doi:10.1097/MCO.0000000000000858.
[20]	ZHAO H, HAN Y, PENG K R, et al. Nasogastric or nasojejunal feeding in pediatric acute pancreatitis:a randomized controlled trial[J]. World J Pediatr, 2021, 17(5):536-543. doi:10.1007/s12519-021-00441-0.

组别		ALB/（g/L）				TP/（g/L）
组别		干预前		干预后	t	干预前		干预后	t
肠外营养组		31.08±2.68		35.24±3.52	6.715^＊＊	55.39±9.28		75.36±8.92	11.080^＊＊
序贯化营养组		31.19±2.74		40.88±4.03	7.265^＊＊	55.01±9.51		83.71±9.05	15.142^＊＊
t		0.205		7.527^＊＊		0.204		4.693^＊＊
组别	PA/（g/L）			AMS/（U/L）			UAMY/（U/L）
组别	干预前	干预后	t	干预前	干预后	t	干预前	干预后	t
肠外营养组	146.27±17.04	202.09±18.41	15.891^＊＊	1 012.35±120.69	292.06±15.03	42.294^＊＊	1 737.37±284.06	425.16±32.28	32.779^＊＊
序贯化营养组	145.94±16.92	268.02±19.93	18.627^＊＊	1 018.72±125.93	186.15±18.05	56.231^＊＊	1 715.84±290.18	343.06±29.75	36.582^＊＊
t	0.098	17.354^＊＊		0.261	32.201^＊＊		0.379	13.356^＊＊

组别		ALB/（g/L）				TP/（g/L）
组别		干预前		干预后	t	干预前		干预后	t
肠外营养组		31.08±2.68		35.24±3.52	6.715^＊＊	55.39±9.28		75.36±8.92	11.080^＊＊
序贯化营养组		31.19±2.74		40.88±4.03	7.265^＊＊	55.01±9.51		83.71±9.05	15.142^＊＊
t		0.205		7.527^＊＊		0.204		4.693^＊＊
组别	PA/（g/L）			AMS/（U/L）			UAMY/（U/L）
组别	干预前	干预后	t	干预前	干预后	t	干预前	干预后	t
肠外营养组	146.27±17.04	202.09±18.41	15.891^＊＊	1 012.35±120.69	292.06±15.03	42.294^＊＊	1 737.37±284.06	425.16±32.28	32.779^＊＊
序贯化营养组	145.94±16.92	268.02±19.93	18.627^＊＊	1 018.72±125.93	186.15±18.05	56.231^＊＊	1 715.84±290.18	343.06±29.75	36.582^＊＊
t	0.098	17.354^＊＊		0.261	32.201^＊＊		0.379	13.356^＊＊

组别	CD3⁺/%			CD4⁺/%
组别	干预前	干预后	t	干预前	干预后	t
肠外营养组	50.31±6.28	59.02±7.03	6.599^＊＊	31.03±6.33	40.06±6.26	7.244^＊＊
序贯化营养组	50.59±6.42	67.15±6.89	8.692^＊＊	30.79±6.47	45.18±5.77	8.657^＊＊
t	0.223	5.898^＊＊		0.189	4.295^＊＊
组别	CD8⁺/%			CD4⁺/CD8⁺
组别	干预前	干预后	t	干预前	干预后	t
肠外营养组	19.68±3.79	21.94±4.02	2.921^＊	1.44±0.59	1.89±0.48	4.225^＊＊
序贯化营养组	20.01±3.58	22.13±3.96	3.562^＊＊	1.47±0.61	2.25±0.52	5.568^＊＊
t	0.452	0.240		0.252	3.633^＊＊

组别	CD3⁺/%			CD4⁺/%
组别	干预前	干预后	t	干预前	干预后	t
肠外营养组	50.31±6.28	59.02±7.03	6.599^＊＊	31.03±6.33	40.06±6.26	7.244^＊＊
序贯化营养组	50.59±6.42	67.15±6.89	8.692^＊＊	30.79±6.47	45.18±5.77	8.657^＊＊
t	0.223	5.898^＊＊		0.189	4.295^＊＊
组别	CD8⁺/%			CD4⁺/CD8⁺
组别	干预前	干预后	t	干预前	干预后	t
肠外营养组	19.68±3.79	21.94±4.02	2.921^＊	1.44±0.59	1.89±0.48	4.225^＊＊
序贯化营养组	20.01±3.58	22.13±3.96	3.562^＊＊	1.47±0.61	2.25±0.52	5.568^＊＊
t	0.452	0.240		0.252	3.633^＊＊

组别	IgA			IgG			IgM
组别	干预前	干预后	t	干预前	干预后	t	干预前	干预后	t
肠外营养组	2.09±0.24	2.20±0.23	2.363^＊＊	9.16±0.82	9.55±0.86	2.344^＊	0.82±0.21	0.94±0.13	3.470^＊＊
序贯化营养组	2.11±0.25	2.33±0.26	4.356^＊＊	9.20±0.80	9.92±0.83	4.460^＊＊	0.81±0.28	1.27±0.17	10.029^＊＊
t	0.412	2.674^＊＊		0.122	2.211^＊		0.204	11.012^＊＊