Department of Surgery, University of Auckland, Auckland, New Zealand.
Department of Surgery, University of Auckland, Auckland, New Zealand.
Clin Nutr. 2017 Jun;36(3):722-729. doi: 10.1016/j.clnu.2016.06.006. Epub 2016 Jun 16.
Tolerance of oral food is an important criterion for hospital discharge in patients with acute pancreatitis. Patients who develop oral feeding intolerance have prolonged hospitalisation, use additional healthcare resources, and have impaired quality of life. This study aimed to quantify the incidence of oral feeding intolerance, the effect of confounders, and determine the best predictors of oral feeding intolerance.
Clinical studies indexed in three electronic databases (EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials) were reviewed. Incidence and predictor data were meta-analysed and possible confounders were investigated by meta-regression analysis.
A total of 22 studies with 2024 patients met the inclusion criteria, 17 of which (with 1550 patients) were suitable for meta-analysis. The incidence of oral feeding intolerance was 16.3%, and was not affected by WHO region, age, sex, or aetiology of acute pancreatitis. Nine of the 22 studies investigated a total of 62 different predictors of oral feeding intolerance. Serum lipase level prior to refeeding, pleural effusions, (peri)pancreatic collections, Ranson score, and Balthazar score were found to be statistically significant in meta-analyses.
Oral feeding intolerance affects approximately 1 in 6 patients with acute pancreatitis. Serum lipase levels of more than 2.5 times the upper limit of normal prior to refeeding is a potentially useful threshold to identify patients at high risk of developing oral feeding intolerance.
对于急性胰腺炎患者，经口进食耐受是出院的重要标准。经口进食不耐受的患者会延长住院时间、使用更多的医疗保健资源，并降低生活质量。本研究旨在量化经口进食不耐受的发生率、混杂因素的影响，并确定最佳预测因子。
对三个电子数据库（EMBASE、MEDLINE 和 Cochrane 对照试验中心注册库）中的临床研究进行了综述。通过荟萃分析对发生率和预测因子数据进行了分析，并通过荟萃回归分析调查了可能的混杂因素。
共有 22 项研究纳入了 2024 例患者，其中 17 项（1550 例患者）适合进行荟萃分析。经口进食不耐受的发生率为 16.3%，不受世界卫生组织区域、年龄、性别或急性胰腺炎病因的影响。22 项研究中有 9 项共研究了 62 种不同的经口进食不耐受预测因子。在荟萃分析中，发现再喂养前血清脂肪酶水平、胸腔积液、（胰周）积液、Ranson 评分和 Balthazar 评分具有统计学意义。
约有 1/6 的急性胰腺炎患者会出现经口进食不耐受。再喂养前血清脂肪酶水平超过正常值上限的 2.5 倍可能是识别高风险经口进食不耐受患者的一个有用阈值。
