Dong Elizabeth, Chang Jonathan I, Verma Dhruv, Butler Rebecca K, Villarin Cecia K, Kwok Karl K, Chen Wansu, Wu Bechien U
Department of Research and Evaluation, Kaiser Permanente, Pasadena, CA.
Pancreas. 2019 Feb;48(2):176-181. doi: 10.1097/MPA.0000000000001225.
Acute pancreatitis (AP) is a leading cause of hospitalization for a gastrointestinal illness in the United States. We hypothesized that enhanced recovery approaches may lead to earlier time to refeeding in patients with AP.
We performed a double-blind, randomized controlled trial of patients admitted with mild AP from July 2016 to April 2017 at a tertiary medical center. Participants were randomly assigned to receive either enhanced recovery consisting of nonopioid analgesia, patient-directed oral intake, and early ambulation versus standard treatment with opioid analgesia and physician-directed diet. Primary study end point was time to oral refeeding on an intent-to-treat basis. Secondary end points included differences in pancreatitis activity scores, morphine equivalents, length of stay, and 30-day readmissions.
Forty-six participants enrolled. Median age was 53.1 years, and 54.3% were female. There was significant reduction in time to successful oral refeeding in the enhanced recovery versus standard treatment group (median, 13.8 vs 124.8 hours, P < 0.001). Pancreatitis activity scores trended lower at 48 to 96 hours among patients assigned to enhanced recovery (mean, 43.6 vs. 58.9, P = 0.32). No differences found in length of stay or 30-day readmissions.
In this randomized controlled trial, enhanced recovery was safe and effective in promoting earlier time to refeeding in patients hospitalized with AP.
在美国，急性胰腺炎（AP）是胃肠道疾病住院治疗的主要原因。我们推测，强化康复方法可能会使AP患者更早恢复经口进食。
我们于2016年7月至2017年4月在一家三级医疗中心对轻度AP住院患者进行了一项双盲随机对照试验。参与者被随机分配接受强化康复治疗，包括非阿片类镇痛、患者自主经口摄入和早期活动，或接受阿片类镇痛和医生指导饮食的标准治疗。主要研究终点是意向性治疗基础上的经口恢复进食时间。次要终点包括胰腺炎活动评分、吗啡等效剂量、住院时间和30天再入院率的差异。
46名参与者入组。中位年龄为53.1岁，54.3%为女性。与标准治疗组相比，强化康复组成功经口恢复进食的时间显著缩短（中位数，13.8小时对124.8小时，P<0.001）。在接受强化康复治疗的患者中，48至96小时的胰腺炎活动评分呈下降趋势（平均值，43.6对58.9，P=0.32）。住院时间和30天再入院率无差异。
在这项随机对照试验中，强化康复对于促进AP住院患者更早恢复经口进食是安全有效的。
