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document
[ The effects of early enteral nutrition with addition of probiotics on the prognosis of patients suffering from severe acute pancreatitis ] . OBJECTIVE To investigate the curative effect of early enteral nutrition ( EN ) supplemented with probiotics ( bifidobacterium ) in patients with severe acute pancreatitis ( ASP ) . METHODS Seventy SAP cases admitted from January 2005 to October 2012 were randomly assigned into parenteral nutrition ( PN ) group ( n=22 ) , EN group ( n=25 ) and bifidobacterium added EN ( P+EN ) group ( n=23 ) . In P+EN group , patients were given their nutrition the same as that of EN , and also probiotics ( bifidobacterium , 4 capsules every 12 hours , given through nasal gastric tube , each capsule weighing 210 mg ) . The routine treatment including anti-infection and anti-acid agents , and that of inhibition of pancreatic secretion were given , except for the different nutritional interventions in all groups . The blood samples were collected for e same measurements of interleukin-8 ( IL-8 ) and tumor necrosis factor ( TNF-α ) by enzyme linked immunosorbent assay ( ELISA ) , and for the C-reactive protein ( CRP ) , lactic acid dehydrogenase ( LDH ) , white blood cell ( WBC ) count , amylase and lipase by biochemistry assay 1 day before intervention of nutrition , and 7 days and 14 days after intervention . Changes in organ function and outcome were also recorded at the same time points . RESULTS The plasma levels of IL-8 , TNF-α , CRP , LDH , WBC count , amylase and lipase were significantly reduced after nutritional intervention compared with their levels on day 1 before intervention in all three groups . The plasma IL-8 , TNF-α , CRP , lipase , LDH at 14 days after intervention of nutrition in P+EN group were significantly lower than those in PN group and EN group ( IL-8 : 21.00 ± 7.07 μg/L vs. 48.00 ± 10.32 μg/L , 32.00 ± 9.30 μg/L ; TNF-α : 44.3 ± 10.9 ng/L vs. 132.1 ± 34.1 ng/L , 67.8 ± 22.3 ng/L ; CRP : 35.0 ± 12.4 mg/L vs. 103.2 ± 49.2 mg/L , 63.0 ± 29.2 mg/L ; lipase : 269 ± 79 U/L vs. 670 ± 145 U/L , 310 ± 78 U/L ; LDH : 21.8 ± 10.3 U/L vs. 78.1 ± 37.4 U/L , 37.9 ± 25.1 U/L , P < 0.05 or P < 0.01 ) . The WBC count in P+EN group was significantly lower than that in PN group ( 5.9 ± 3.0 × 10⁹/L , 6.3 ± 3.2 × 10⁹/L vs. 9.6 ± 3.0 ×10⁹/L , both P < 0.05 ) , but there was no significant difference in amylase between P+EN group and PN group ( 211 ± 49 U/L , 236 ± 52 U/L vs. 298 ± 71 U/L , P > 0.05 ) . The gastrointestinal dysfunction score in P+EN , EN , PN groups 14 days after nutritional intervention was 0.28 ± 0.05 , 0.43 ± 0.09 , 0.71 ± 0.11 , respectively , with statistically significant differences ( all P < 0.01 ) . Compared with PN and EN groups , the incidence of upper gastrointestinal bleeding ( 1 vs. 9 , 2 ) , infection and abscess ( 2 vs. 12 , 5 ) was lower ( all P < 0.01 ) , and hospital day was significantly shortened in P+EN group ( 10.4 ± 3.9 days vs. 25.8 ± 6.4 days , 13.4 ± 5.2 days , both P < 0.01 ) . There was no significant statistical difference in mortality rate among three groups . CONCLUSION Our results indicated that early EN with addition of probiotics ( bifidobacterium ) resulted in significant lowering of the level of pro-inflammatory cytokines , earlier restoration of gastrointestinal function , decrease of complications such as infection , and shortening of hospital day in patients with SAP .
59516
Intervention_Pharmacological
early enteral nutrition with addition of probiotics
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Intervention_Pharmacological
early enteral nutrition ( EN ) supplemented with probiotics ( bifidobacterium )
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Intervention_Pharmacological
parenteral nutrition ( PN )
59519
Intervention_Pharmacological
EN
59520
Intervention_Pharmacological
bifidobacterium added EN ( P+EN )
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Intervention_Pharmacological
P+EN
59522
Intervention_Pharmacological
EN
59523
Intervention_Pharmacological
probiotics ( bifidobacterium
59524
Intervention_Pharmacological
anti-infection and anti-acid agents
59525
Outcome_Physical
plasma levels of IL-8 , TNF-α
59526
Outcome_Physical
CRP
59527
Outcome_Physical
LDH
59528
Outcome_Physical
WBC count
59529
Outcome_Physical
amylase
59530
Outcome_Physical
lipase
59531
Outcome_Physical
plasma IL-8 , TNF-α , CRP
59532
Outcome_Physical
lipase
59533
Outcome_Physical
LDH
59534
Outcome_Adverse-effects
incidence
59535
Outcome_Adverse-effects
upper gastrointestinal bleeding
59536
Participant_Condition
severe acute pancreatitis
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Participant_Condition
severe acute pancreatitis ( ASP )
59538
Participant_Sample-size
Seventy