From the Department of Acute Care and General Medicine, Saiseikai Kumamoto Hospital, Kumamoto.
Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama.
Pancreas. 2021 Mar 1;50(3):371-377. doi: 10.1097/MPA.0000000000001768.
In patients with severe acute pancreatitis (SAP), early enteral nutrition (EN) is recommended by major clinical practice guidelines, but the exact timing for the initiation of EN is unknown.
We conducted a post hoc analysis of the database for a multicenter (44 institutions) retrospective study of patients with SAP in Japan. The patients were classified into 3 groups according to the timing of EN initiation after the diagnosis of SAP: within 24 hours, between 24 and 48 hours, and more than 48 hours. The primary outcome was in-hospital mortality.
Of the 1094 study patients, 176, 120, and 798 patients started EN within 24 hours, between 24 and 48 hours, and more than 48 hours after SAP diagnosis, respectively. On multivariable analysis, hospital mortality was significantly better with EN within 48 hours than with more than 48 hours (adjusted odds ratio, 0.49; 95% confidence interval, 0.29-0.83; P < 0.001) but did not significantly differ between the groups with EN starting within 24 hours and between 24 and 48 hours (P = 0.29).
Enteral nutrition within 24 hours may not confer any additional benefit on clinical outcomes compared with EN between 24 and 48 hours.
对于重症急性胰腺炎（SAP）患者，主要临床实践指南推荐早期肠内营养（EN），但 EN 启动的确切时机尚不清楚。
我们对日本多中心（44 家机构）SAP 患者回顾性研究数据库进行了事后分析。根据 SAP 确诊后 EN 启动的时间，患者分为 3 组：24 小时内、24 至 48 小时内和超过 48 小时。主要结局是院内死亡率。
在 1094 名研究患者中，分别有 176、120 和 798 名患者在 SAP 确诊后 24 小时内、24 至 48 小时内和超过 48 小时内开始 EN。多变量分析显示，与超过 48 小时相比，48 小时内给予 EN 可显著降低住院死亡率（调整优势比，0.49；95%置信区间，0.29-0.83；P < 0.001），但与 24 小时内和 24 至 48 小时内开始 EN 的组之间无显著差异（P = 0.29）。
与 24 至 48 小时内给予 EN 相比，24 小时内给予肠内营养可能不会对临床结局带来额外获益。
