Oláh A, Pardavi G, Belágyi T
Petz Aladár Megyei Kórház, Sebészeti Osztály
Magy Seb. 2000 Feb;53(1):7-12.
Authors evaluate the effect of early jejunal feeding on septic complications and mortality in acute pancreatitis, based on the results of a two-phase, prospective, randomized study. In the first part of the study they compared the conventional parenteral nutrition with early (started within 24 hours) enteral nutrition in a prospective, randomized trial on 89 patients. Forty-eight patients were randomized into the parenteral group "A" (Rindex 10, Infusamin S, Intralipid 10%: 30 kcal/kg) and 41 patients into the enteral group "B" (fed by nasogastric jejunal tube Survimed OPD, 30 kcal/kg). The rate of septic complications (infected necrosis, abscess, infected pseudocyst) were significantly lower in the enteral group (p = 0.08 chi-square test). In the second phase of the study early jejunal feeding was combined with imipenem prophylaxis (Tienam, 2 x 500 mg i.v.) in the necrotizing cases detected by CT scan. According to the results of 92 patients the rate of septic complications (p = 0.03), multiple organ failure (p = 0.14), and mortality (p = 0.13) were further reduced in this group. Authors believe that combination of early enteral nutrition and a selective, adequate antibiotic therapy may give a chance for prevention of multiple organ failure.
作者基于一项两阶段前瞻性随机研究的结果，评估早期空肠喂养对急性胰腺炎感染性并发症和死亡率的影响。在研究的第一部分，他们在一项针对89例患者的前瞻性随机试验中，将传统肠外营养与早期（24小时内开始）肠内营养进行了比较。48例患者被随机分为肠外营养组“A”（瑞代10，英脱利匹特10%：30千卡/千克），41例患者被分为肠内营养组“B”（通过鼻空肠管给予苏威美OPD，30千卡/千克）。肠内营养组的感染性并发症（感染性坏死、脓肿、感染性假性囊肿）发生率显著更低（卡方检验，p = 0.08）。在研究的第二阶段，对于CT扫描检测到的坏死性病例，早期空肠喂养联合亚胺培南预防治疗（泰能，2×500毫克静脉注射）。根据92例患者的结果，该组的感染性并发症发生率（p = 0.03）、多器官功能衰竭发生率（p = 0.14）和死亡率（p = 0.13）进一步降低。作者认为，早期肠内营养与选择性、充分的抗生素治疗相结合，可能为预防多器官功能衰竭提供机会。
