Dissertation > Excellent graduate degree dissertation topics show

Efficacy of Early Enteral Nutrition and Total Parenteral Nutrition in Patients with Severe Acute Pancreatitis: a Meta-analysis

Author: ZhongZhiLing
Tutor: JiangChunMeng
School: Dalian Medical University
Course: Digestion within the science
Keywords: Early enteral nutrition Total parenteral nutrition Severe acute pancreatitis Randomized controlled trial Meta-analysis
CLC: R576
Type: Master's thesis
Year: 2013
Downloads: 20
Quote: 0
Read: Download Dissertation


Background: Severe acute pancreatitis (SAP) is a common clinical acuteabdomen,patients often have rapid onset and high fatality rate. Patients with SAP athigh catabolism state and the negative nitrogen balance, so energy consumption increasesignificantly. At the same time, SAP can also lead to serious metabolic disorder.Nutrition support is an important treatment measure for SAP. Total parenteral nutrition(TPN) is the traditional model of nutritional support. TPN can inhibit pancreaticsecretion, reduce gastrointestinal burden, but also to modify the intestinal barrierfunction and influence the health. Early enteral nutrition (EEN) is another way ofnutritional support. EEN can maintain the structure and function of intestinal mucosaand reducing occurrence of enterogenic infection, but the patients can easily causegastrointestinal discomfort. So there is still debate on which should be used in SAP,EEN or TPN.Objective:To evaluate the clinical efficacy and safety of EEN and TPN in patientswith SAP. Using meta-analysis to provides the basis of the evidence-based medicine forclinical practice.Methods: Randomized controlled trial (RCT) that compared EEN with TPN weresearched in MEDLINE, PubMed, China Biological Medicine Database(CBM), ChinaNational Knowledge Infrastructure Whole Article Database(CNKI), VIP ChineseJournals Database and Google Scholar, and the relevant references of the includedarticles were also manually searched. The retrieval time from january1966to january2013. The RCTs do not meet the inclusion criteria were ruled out by reading articlestitle, abstract or the full text. The outcome indexes were case fatality rate, pancreaticinfection incidence, incidence of multiple organ failure, surgical intervention incidence,diarrhea incidence and incidence of high blood sugar. Meta-analysis were performed with Revman5.2software after we assessed the article quality and extracted the data.Results:Nine RCTs involving453patients with SAP were included. EEN grouphas221patients, TPN group has232patients. All patients in EEN group implementedenteral nutrition through distal jejunum way, and the beginning of the treatment timewithin72hours. The result of meta-analysis showed that compared with TPN, EENcould significantly reduce case fatality rate〔RR=0.35、95%C(I0.20,0.61)、P=0.0002〕,pancreatitis-related infection〔RR=0.41、95%CI(0.24,0.71)、P=0.001〕,requiredrate of surgical intervention〔RR=0.50、95%CI(0.35,0.70)、P<0.0001〕,incidenceof multiple organ failure〔RR=0.37、95%CI(0.18,0.77)、P=0.008〕,and incidenceof high blood sugar〔RR=0.47、95%CI(0.24,0.93)、P=0.03〕. But EEN had a higherincidence in diarrhea〔RR=5.54、95%CI(2.44,12.57)、P<0.0001〕.Conclusion: Current study show that EEN can significantly reduce case fatalityrate and surgical intervention incidence of patients with SAP. At the same time, EENcan also reduce pancreatitis-related infection, multiple organ failure and high bloodsugar. EEN contributes to the prognosis of patients. Therefore, SAP patients withoutenteral nutrition contraindications should choose EEN as the first way of nutritionsupport.

Related Dissertations

  1. Methodology for Linkage-map-based Quantitative Trait Loci Synthesis Analysis,S562
  2. Dual-source CT in the Diagnosis of Coronary Artery Stenosis: a Meta Analysis,R541.4
  3. Malignant Transformation of Ovarian Endometriosis-related Protein Expression in the Meta-Analysis,R711.71
  4. The Changes of Intestinal Barrier Functional in Rats with SAP and the Effection of QingYi Ⅱ,R657.51
  5. Heterogeneity and Meta Analysis of the Essential Hypertension Risk Assessments,R544.1
  6. Association of Interleukin-6 Gene Polymorphisms with Susceptibility to Coronary Heart Disease in Asian Populations: a Meta-analysis,R541.4
  7. Effects of Health Education Managment on the Asthma Control: Meta-analysis,R562.25
  8. Bone marrow mesenchymal stem cells in rats with severe acute pancreatitis CD4 ~ CD25 ~ regulatory T cells influence and Integrative Medicine,R576
  9. Isoflavone intake and the risk of breast and prostate cancer Meta-analysis,R737.25
  10. Rhubarb , magnesium sulfate treatment of severe acute pancreatitis comparative study of the clinical efficacy,R576
  11. A Meta-analysis of Total Parenteral Nutrition and Early Enteral Nutrition in Patients with Severe Acute Pancreatitis,R576
  12. The Effects of Total Parenteral Nutrition on the Expression of Rat Liver Toll-like Receptors,R459.3
  13. Diagnostic Value of Serum SP-A and SP-D of Severe Acute Pancreatitis(SAP)-induced Acute Lung Injury(ALI),R563.8
  14. An Evidence-based Study on Risk Prediction of Alzheimer’s Disease,R749.16
  15. Diagnostic Value of MRI for Small Bowel Crohn’s Disease: A Meta-Analysis,R574
  16. Meta Analysis of the Relationship between IL-6 or TNF-α and Human Primary Hepatocellular Carcinomas,R735.7
  17. The Clinical Value of and Curative Effect of Therapeutic ERCP in Serious Pancreatic Diseases,R657.51
  18. Protective Effect of Edaravone in the Intestinal Mucosal Barrier Injury of Severe Acute Pancreatitis in Rats,R965
  19. Fine perioperative heart rate regulation is the implementation of the premise and basis of myocardial protection,R619
  20. Rivaroxaban Versus Enoxaparin for Prevention of Deep Venous Thrombosis after Major Orthopedic Operation: A Systematic Review,R687
  21. Systematic Review of Laparoscopic Choledocholithotomy Combined with Choledochoscopy and Open Surgery for Common Bile Duct Stones,R657.4

CLC: > Medicine, health > Internal Medicine > Digestive and abdominal diseases > Pancreatic diseases
© 2012 www.DissertationTopic.Net  Mobile