Li Xueping, Ma Fengbo, Jia Kezhi
Department of Gastroenterology, Shouguang People's Hospital, Weifang, Shandong, China (mainland).
Department of Gastroenterology, People's Hospital of Binzhou, Binzhou, Shandong, China (mainland).
Med Sci Monit. 2014 Nov 17;20:2327-35. doi: 10.12659/MSM.892770.
Although (EEN) is a relatively safer route by which to feed patients with severe acute pancreatitis (SAP) or predicted SAP (pSAP) compared to total parental nutrition (TPN), the appropriate starting time for EEN administration after admission is still controversial. This study pooled all relevant studies to assess the complications associated with EEN by stratifying relevant RCTs into subgroups according to the starting time (<24 h or between 24 and 72 h after admission).
MATERIAL/METHODS: Relevant studies were searched for among 5 databases. The association between intervention and complications, including pancreatic infection, mortality, hyperglycemia, organ failure, and catheter-related septic complications, were assessed by using pooled risk ratio (RR) and the corresponding 95% confidential interval (CI).
Twelve RCTs were identified through our literature search. Pooled analysis showed that EEN, but not TPN or delayed enteral nutrition (DEN), is associated with reduced risk of pancreatic infection, mortality, organ failure, hyperglycemia, and catheter-related septic complications. EEN within 24 h of admission presented significantly better outcome in morality than EEN between 24 and 72 h. However, no significant heterogeneity was observed in the risk of pancreatic infection, organ failure, hyperglycemia, and catheter-related septic complications between the 2 subgroups.
If the patients are reasonably expected to have high compliance to EN therapy, it could be considered as early as possible.
与全肠外营养（TPN）相比，尽管早期肠内营养（EEN）是为重症急性胰腺炎（SAP）或预测为SAP（pSAP）的患者提供营养的相对更安全的途径，但入院后开始给予EEN的合适时间仍存在争议。本研究汇总了所有相关研究，根据开始时间（入院后<24小时或24至72小时）将相关随机对照试验（RCT）分层为亚组，以评估与EEN相关的并发症。
材料/方法：在5个数据库中检索相关研究。通过使用合并风险比（RR）和相应的95%置信区间（CI）评估干预措施与并发症之间的关联，这些并发症包括胰腺感染、死亡率、高血糖、器官衰竭和导管相关的败血症并发症。
通过文献检索确定了12项RCT。汇总分析表明，EEN与胰腺感染、死亡率、器官衰竭、高血糖和导管相关的败血症并发症风险降低相关，而TPN或延迟肠内营养（DEN）则不然。入院后24小时内给予EEN在死亡率方面的结局明显优于24至72小时给予EEN。然而，两个亚组之间在胰腺感染、器官衰竭、高血糖和导管相关的败血症并发症风险方面未观察到显著异质性。
如果合理预期患者对肠内营养治疗的依从性较高，则可尽早考虑给予肠内营养。
