Mangiante Gerardo, Vantini Italo, Ciola Michele, Colucci Gianluca, Benini Luigi, Serio Giovanni
Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Università degli Studi di Verona, Piazzale L.A. Scuro, 10-37134 Verona.
Chir Ital. 2003 Jan-Feb;55(1):21-8.
During recent years, there has been considerable debate as to the nutritional supply that needs to be established for a patient with acute pancreatitis. The main problem is still infection of the pancreatic necrosis, which has a decisive bearing on the indication for surgery and is the main cause of mortality. Infection stems from bacterial translocation from the patient's gut. Enteral nutrition with its known potential for reducing this type of infection constitutes an attempt to prevent it by preserving the enteric mucosal barrier. Today, the concept of pancreatic rest is no longer considered mandatory in the guidelines of many Surgical and Nutritional Societies, whilst enteral nutrition is the gold standard for acute pancreatitis. Assuring an integrated parenteral and enteral supply before reaching the full regimen of enteral nutrition is the most reliable policy during the early days of the disease. Moreover, outcomes being equal, enteral nutrition is cheaper than parenteral nutrition, as has been extensively demonstrated in many clinical trials in severe acute pancreatitis.
近年来，关于为急性胰腺炎患者确定所需营养供应一直存在大量争论。主要问题仍然是胰腺坏死感染，这对手术指征具有决定性影响，并且是死亡的主要原因。感染源于患者肠道的细菌移位。肠内营养具有降低此类感染的已知潜力，它试图通过保护肠黏膜屏障来预防感染。如今，在许多外科和营养学会的指南中，胰腺休息的概念不再被认为是强制性的，而肠内营养是急性胰腺炎的金标准。在疾病早期，在达到完全肠内营养方案之前确保肠外和肠内营养的综合供应是最可靠的策略。此外，在许多重症急性胰腺炎的临床试验中已广泛证明，在结果相同的情况下，肠内营养比肠外营养便宜。
