Al-Omran M, Groof A, Wilke D
General Surgery, University of Toronto, 3403-38 Elm Street, Toronto, Ontario, Canada, M5G 2K5.
Cochrane Database Syst Rev. 2003(1):CD002837. doi: 10.1002/14651858.CD002837.
Acute pancreatitis creates a catabolic stress state promoting a systemic inflammatory response and nutritional deterioration. Adequate supply of nutrients plays an important role to ensure optimum recovery. Total parenteral nutrition (TPN) has been the standard practice for providing exogenous nutrients to patients with severe acute pancreatitis. However, recent data suggest that enteral nutrition (EN) is feasible. Thus, a comparison of EN and TPN in patients with acute pancreatitis needs to be made.
To compare the effect of total parenteral nutrition (TPN) versus enteral nutrition (EN) on mortality, morbidity and length of hospital stay in patient with acute pancreatitis.
Trials were identified by computerized searches of The Cochrane Controlled Trials Register, MEDLINE, and EMBASE. Additional studies were identified and included where relevant by searching Scisearch, the bibliographies of review articles and identified trials, and personal files. The search was undertaken in August, 2000 and updated in September 2002. No language restrictions were applied.
Randomized clinical trials, in which nutrition support with TPN were compared to EN in patients with acute pancreatitis.
Two reviewers independently abstracted data and assessed trial quality. Information was collected on death, length of hospital stay, systemic infection, local septic complications, and other local complications.
Two trials with a total of 70 participants were included. The relative risk (RR) for death with EN vs TPN was 0.56 (95% CI 0.05 to 5.62). Mean length of hospital stay was reduced with EN (WMD -2.20, 95% CI -3.62 to -0.78). RR for systemic infection with EN vs TPN was 0.61 (95% CI 0.29 to 1.28). In one trial, RR for local septic complications and other local complications with EN vs TPN was 0.56 (95% CI 0.12 to 2.68) and 0.16 (95% CI 0.01 to 2.86) respectively.
REVIEWER'S CONCLUSIONS: Although there is a trend towards reductions in the adverse outcomes of acute pancreatitis after administration of EN, clearly there are insufficient data to draw firm conclusions about the effectiveness and safety of EN versus TPN. Further trials are required with sufficient size to account for clinical heterogeneity and to measure all relevant outcomes.
急性胰腺炎会引发分解代谢应激状态，促进全身炎症反应和营养状况恶化。充足的营养供应对于确保最佳恢复起着重要作用。全肠外营养（TPN）一直是为重症急性胰腺炎患者提供外源性营养的标准做法。然而，近期数据表明肠内营养（EN）是可行的。因此，需要对急性胰腺炎患者的肠内营养和全肠外营养进行比较。
比较全肠外营养（TPN）与肠内营养（EN）对急性胰腺炎患者死亡率、发病率及住院时间的影响。
通过计算机检索Cochrane对照试验注册库、MEDLINE和EMBASE来识别试验。通过检索Scisearch、综述文章的参考文献及已识别试验以及个人文档来识别并纳入其他相关研究。检索于2000年8月进行，并于2002年9月更新。未设语言限制。
随机临床试验，其中将急性胰腺炎患者的全肠外营养支持与肠内营养进行比较。
两名评价员独立提取数据并评估试验质量。收集了关于死亡、住院时间、全身感染、局部脓毒症并发症及其他局部并发症的信息。
纳入两项试验，共70名参与者。肠内营养与全肠外营养相比的死亡相对风险（RR）为0.56（95%可信区间0.05至5.62）。肠内营养可缩短平均住院时间（加权均数差 -2.20，95%可信区间 -3.62至 -0.78）。肠内营养与全肠外营养相比的全身感染RR为0.61（95%可信区间0.29至1.28）。在一项试验中，肠内营养与全肠外营养相比的局部脓毒症并发症及其他局部并发症的RR分别为0.56（95%可信区间0.12至2.68）和0.16（95%可信区间0.01至2.86）。
尽管给予肠内营养后急性胰腺炎不良结局有降低趋势，但显然尚无足够数据就肠内营养与全肠外营养的有效性和安全性得出确凿结论。需要进行规模足够大的进一步试验，以考虑临床异质性并衡量所有相关结局。
