Jensen Kristine B, Chan Daniel L
Department of Clinical Science and Services, The Royal Veterinary College, University of London, North Mymms, Hertfordshire, United Kingdom.
J Vet Emerg Crit Care (San Antonio). 2014 May-Jun;24(3):240-50. doi: 10.1111/vec.12180. Epub 2014 Apr 1.
To review current and emerging nutritional approaches in the management of acute pancreatitis (AP) in people, dogs, and cats, and to provide a framework for further investigation in this field.
Veterinary retrospective studies and reviews, human prospective clinical trials and reviews, and experimental animal studies focusing on nutritional management during AP.
Nutritional management is an important part of the treatment plan for patients with AP. In human medicine, the general approach for providing nutrition in patients with AP has changed in recent years and favors enteral over parenteral nutrition with an emphasis on early enteral nutrition (EN). Although there are limited data available, there is increasing evidence in the veterinary literature that supports the beneficial role of EN in AP and contradicts previous assumptions about poor tolerance to enteral feeding in this patient population. Parenteral nutrition may be appropriate alone or in combination with EN as a temporary measure in malnourished patients that do not tolerate adequate EN; however, enteral feeding should be attempted first in most cases. Immunonutrition is being investigated for its positive role in modulating pancreatic inflammation and improving gut barrier function in cases of human AP.
The nutritional management of veterinary patients with AP remains challenging. Based on clinical evidence in people, experimental animal studies, and preliminary studies in dogs and cats, the choice of EN over parenteral nutritional support during AP in dogs and cats appears to be beneficial and well tolerated. Optimization of nutritional therapies in dogs and cats including the use of immunonutrition during AP warrants further investigation.
回顾目前及新兴的针对人、犬和猫急性胰腺炎（AP）管理的营养方法，并为该领域的进一步研究提供框架。
兽医回顾性研究与综述、人类前瞻性临床试验与综述，以及聚焦于AP期间营养管理的实验动物研究。
营养管理是AP患者治疗计划的重要组成部分。在人类医学中，近年来为AP患者提供营养的一般方法已发生变化，更倾向于肠内营养而非肠外营养，强调早期肠内营养（EN）。尽管现有数据有限，但兽医文献中有越来越多的证据支持EN在AP中的有益作用，这与之前关于该患者群体对肠内喂养耐受性差的假设相矛盾。对于不耐受充足EN的营养不良患者，肠外营养单独使用或与EN联合使用作为临时措施可能是合适的；然而，在大多数情况下应首先尝试肠内喂养。免疫营养因其在调节人类AP病例中的胰腺炎症和改善肠道屏障功能方面的积极作用而正在接受研究。
兽医AP患者的营养管理仍然具有挑战性。基于人类临床证据、实验动物研究以及犬猫的初步研究，犬猫AP期间选择EN而非肠外营养支持似乎是有益的且耐受性良好。优化犬猫的营养疗法，包括在AP期间使用免疫营养，值得进一步研究。
