Machicado Jorge D, Gougol Amir, Paragomi Pedram, OʼKeefe Stephen J, Lee Kenneth, Slivka Adam, Whitcomb David C, Yadav Dhiraj, Papachristou Georgios I
Department of Surgery, University of Pittsburgh Medical Center.
Pancreas. 2018 Oct;47(9):1150-1155. doi: 10.1097/MPA.0000000000001141.
Clinical trials on tube feedings (TFs) have not been sufficiently powered to change practice patterns in acute pancreatitis (AP). We aimed to describe the use, duration, and resource utilization of TF in AP patients at an expert US center.
Of 423 AP patients prospectively enrolled at the University of Pittsburgh Medical Center from 2004 to 2014, 139 (33%) received TF. Data on TF were assessed in 100 (72%) of 139 patients with complete data available.
Patients on TF were more likely to be male, be obese, have alcohol etiology, and have moderately severe (34% vs 19%) or severe AP (62% vs. 3%) (P < 0.05). Tube feedings were started after a median of 5 days (interquartile range, 3-8 days) from admission and were administered for a median of 39 days (interquartile range, 19-58 days). A nasojejunal route (95%) with an oligomeric formula (92%) was the preferred TF strategy. Feeding tube complications led to at least 1 endoscopic tube replacement in 42% of patients and to an unexpected health care visit in 29% of those discharged on TF (16/55 patients).
Tube feedings form an important component in the management of patients with moderately severe and severe AP. Further studies should define the optimal utilization of TF and ways to reduce TF-related complications.
关于管饲（TF）的临床试验尚无足够的效力来改变急性胰腺炎（AP）的治疗模式。我们旨在描述美国一家专业中心AP患者中TF的使用情况、持续时间和资源利用情况。
2004年至2014年在匹兹堡大学医学中心前瞻性登记的423例AP患者中，139例（33%）接受了TF。在139例有完整可用数据的患者中，对其中100例（72%）的TF数据进行了评估。
接受TF的患者更可能为男性、肥胖、有酒精性病因，且患有中度重症（34%对19%）或重症AP（62%对3%）（P<0.05）。管饲在入院中位数5天（四分位间距，3 - 8天）后开始，中位持续39天（四分位间距，19 - 58天）。鼻空肠途径（95%）联合低聚配方（92%）是首选的TF策略。饲管并发症导致42%的患者至少进行1次内镜下饲管更换，29%接受TF出院的患者（16/55例患者）出现意外的医疗就诊。
管饲是中度重症和重症AP患者管理中的重要组成部分。进一步的研究应明确TF的最佳利用方式以及减少与TF相关并发症的方法。
