Imrie Clement W, Carter C Ross, McKay Colin J
Lister Department of Surgery, Royal Infirmary, Glasgow, G31 2ER, Scotland, UK.
Best Pract Res Clin Gastroenterol. 2002 Jun;16(3):391-7. doi: 10.1053/bega.2002.0314.
In the last 5 years naso-enteric feeding has increasingly been used in clinical practice in patients with severe acute pancreatitis. Randomized clinical studies in both mild and severe forms of the disease have demonstrated not only the feasibility but also the safety of this approach. The majority of patients have been fed by variously placed nasojejunal tubes with varied problems in maintaining both location and patency. Most have been surprised to find that it is possible to feed the patients in this way with the potential of improving gut barrier function and immune response, at reduced cost and greater safety than with parenteral nutrition. The current evidence points to nasojejunal feeding being preferable to parenteral feeding, but evidence has yet to be produced to prove beyond reasonable doubt that such feeding is an improvement on conservative management without feeding. Finally, the most recent development has indicated that fine-bore nasogastric feeding may well be a realistic alternative to nasojejunal feeding even in the more severe forms of this disease. A small percentage of patients may still need parenteral nutrition.
在过去5年中，鼻肠喂养在重症急性胰腺炎患者的临床实践中越来越多地被使用。针对该疾病轻、重症形式的随机临床研究不仅证明了这种方法的可行性，还证明了其安全性。大多数患者通过不同位置放置的鼻空肠管进行喂养，在维持管道位置和通畅方面存在各种问题。大多数人惊讶地发现，以这种方式喂养患者是可行的，它有可能改善肠道屏障功能和免疫反应，而且与肠外营养相比，成本更低、安全性更高。目前的证据表明，鼻空肠喂养优于肠外喂养，但尚未有证据能确凿证明这种喂养方式比不进行喂养的保守治疗更具优势。最后，最新进展表明，即使在该疾病的更严重形式中，细孔鼻胃喂养很可能是鼻空肠喂养的一种切实可行的替代方法。仍有一小部分患者可能需要肠外营养。
