Marik Paul E
Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Curr Opin Crit Care. 2009 Apr;15(2):131-8. doi: 10.1097/MCC.0b013e328319910a.
Patients with acute pancreatitis have traditionally been treated with 'bowel rest'. Recent data, however, suggest that this approach may be associated with increased morbidity and mortality. This paper reviews evolving concepts in the nutritional management of patients with acute pancreatitis.
Both experimental and clinical data strongly support the concept that enteral nutrition started within 24 h of admission to hospital reduces complications, length of hospital stay and mortality in patients with acute pancreatitis. Clinical trials suggest that both gastric and jejunal tube feeding is well tolerated in patients with severe pancreatitis. Although there is limited data for the optimal type of enteral feed, a semielemental formula with omega-3 fatty acids is recommended. On the basis of current evidence, immune modulating formulas with added arginine and probiotics are not recommended.
Nutritional support should be viewed as an active therapeutic intervention that improves the outcome of patients with acute pancreatitis. Enteral nutrition should begin within 24 h after admission and following the initial period of volume resuscitation and control of nausea and pain. Patients with mild acute pancreatitis should be started on a low-fat oral diet. In patients with severe acute pancreatitis, enteral nutrition may be provided by the gastric or jejunal route.
传统上，急性胰腺炎患者采用“肠道休息”治疗。然而，近期数据表明，这种方法可能会增加发病率和死亡率。本文综述了急性胰腺炎患者营养管理方面不断发展的概念。
实验和临床数据均有力支持以下观点，即入院24小时内开始肠内营养可降低急性胰腺炎患者的并发症、缩短住院时间并降低死亡率。临床试验表明，重症胰腺炎患者对胃管和空肠管饲喂养的耐受性良好。尽管关于最佳肠内营养类型的数据有限，但推荐使用含ω-3脂肪酸的半要素配方。基于目前的证据，不推荐添加精氨酸和益生菌的免疫调节配方。
营养支持应被视为一种积极的治疗干预措施，可改善急性胰腺炎患者的预后。肠内营养应在入院后24小时内开始，并在初始阶段进行容量复苏以及控制恶心和疼痛之后开始。轻度急性胰腺炎患者应开始低脂口服饮食。对于重症急性胰腺炎患者，可通过胃或空肠途径提供肠内营养。
