Clinical effect of early enteral nutrition combined with glutamine and low molecular heparin on severe pancreatitis in elderly patients

Li Xiang

doi:10.3760/cma.j.issn.1673-4777.2018.04.020

Abstract：Objective To observe the clinical effect of early enteral nutrition combined with glutamine and low molecular heparin on severe pancreatitis in elderly patients.Methods A total of 88 elderly patients with severe pancreatitis admitted from January 2015 to January 2017 in Chongqing Three Gorges Central Hospital were randomly divided into observation group(44 cases) and control group(44 cases).All patients had basic treatments of fasting and gastrointestinal decompression.The control group had intravenous drip of omeprazole sodium 2 times/d and slow injection of somatostatin.The observation group was treated by early enteral nutrition combined with glutamine and low molecular heparin.The course of treatments was 10 d.Recovery time of abdominal pain,abdominal distention,bowel gurgling sound,defecation and body temperature,incidence rates of acute respiratory distress syndrome(ARDS) and multiple organ dysfunction syndrome(MODS) in 4 weeks,blood gas indexes and score of the acute physiology and chronic health evaluation Ⅱ (APACHE) before and 72 h after treatment,serum levels of high mobility group box B1 (HMGB1) and receptor for advanced glycation end products(RAGE) 72 h after treatment were analyzed.Results Recovery time of abdominal pain,abdominal distention,bowel gurgling sound,defecation and body temperature in observation group were significantly shorter than those in control group (P ＜0.01).Iucidence rates of ARDS and MODS in 4 weeks in observation group were significantly lower than those in control group[11.4％ (5/44) vs 31.8％ (14/44),13.6％ (6/44) vs 36.4％ (16/44)] (P ＜ 0.05).After treatment,arterial oxygen partial pressure and saturation in observation group were significantly higher than those in control group [(90 ± 10) mmHg vs (76 ± 9) mmHg,(97 ± 10) ％ vs (92 ± 10) ％] (P ＜ 0.01);arterial partial pressure of carbon dioxide and the APACHE Ⅱ score in observation group were significantly lower than those in control group[(45 ±5) mmHg vs (59 ±6)mmHg,(5.0±0.6)points vs (6.5 ±0.8)points](P＜0.01);serum levels of HMGB1 and RAGE in observation group were significantly lower than those in control group [(21±3)μg/L vs (37±4)μg/L,(5.3±0.6)μg/L vs (7.4±0.9)μg/L](P＜0.01).Conclusion Early enteral nutrition combined with glutamine and molecular heparin can reduce HMGB1 and RAGE;it is effective in treating severe pneunonia in elderly patient.