Department of Gastroenterology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland.
Pancreas. 2013 May;42(4):640-6. doi: 10.1097/MPA.0b013e318271bb61.
The exact time of initiation of total enteral nutrition (TEN) in severe acute pancreatitis (SAP) and its influence on the disease outcome are not well known.
An analysis of 197 cases with predicted SAP allocated to: group A (n = 97), early TEN (started within the first 48 hours after admission to hospital); and group B (n = 100), delayed TEN (started after 48 hours).
Infection of necrosis/fluid collections occurred in 4 patients in group A and 18 patients in group B (P < 0.05). Respiratory failure and transfer to intensive care unit occurred more frequently in group B than in group A (15 vs 5 and 15 vs 3 patients; P < 0.05). Multiple-organ failure was observed in 9 patients in group A and 16 patients in group B (P > 0.05). Seven patients in group A and 11 patients in group B underwent surgery (P > 0.05). All 9 reported deaths occurred in group B (P < 0.05). The time to start TEN was a predictor of infected necrosis/fluid collection (odds ratio, 4.09; P = 0.028).
Delayed compared to early TEN is associated with higher mortality, increased frequency of infected necrosis/fluid collections, respiratory failure, and a need for intensive care unit hospitalization. Enteral nutrition in SAP should be started within 48 hours after admission to hospital.
重症急性胰腺炎（SAP）患者开始全肠内营养（TEN）的确切时间及其对疾病结局的影响尚不清楚。
对 197 例预测 SAP 的患者进行分析，分为：A 组（n = 97），早期 TEN（入院后 48 小时内开始）；B 组（n = 100），延迟 TEN（48 小时后开始）。
A 组有 4 例患者发生坏死/积液感染，B 组有 18 例患者发生感染（P < 0.05）。B 组呼吸衰竭和转入重症监护病房的患者比 A 组多（15 例比 5 例，15 例比 3 例；P < 0.05）。A 组有 9 例患者发生多器官功能衰竭，B 组有 16 例患者发生多器官功能衰竭（P > 0.05）。A 组有 7 例患者和 B 组有 11 例患者接受了手术（P > 0.05）。B 组有 9 例死亡病例（P < 0.05）。开始 TEN 的时间是感染性坏死/积液的预测因素（比值比，4.09；P = 0.028）。
与早期 TEN 相比，延迟 TEN 与更高的死亡率、感染性坏死/积液的发生率增加、呼吸衰竭和需要重症监护病房住院治疗相关。SAP 患者应在入院后 48 小时内开始肠内营养。
