Kalfarentzos F, Kehagias J, Mead N, Kokkinis K, Gogos C A
Department of Surgery, University of Patras, Greece.
Br J Surg. 1997 Dec;84(12):1665-9.
Parenteral nutrition is well established for providing nutritional support in acute pancreatitis while avoiding pancreatic stimulation. However, it is associated with complications and high cost. Benefits of enteral feeding in other disease states prompted a comparison of early enteral feeding with total parenteral nutrition in this clinical setting.
Thirty-eight patients with acute severe pancreatitis were randomized into two groups. The first (n = 18) received enteral nutrition through a nasoenteric tube with a semi-elemental diet, while the second group (n = 20) received parenteral nutrition through a central venous catheter. Safety was assessed by clinical course of disease, laboratory findings and incidence of complications. Efficacy was determined by nitrogen balance. The cost of nutritional support was calculated.
Enteral feeding was well tolerated without adverse effects on the course of the disease. Patients who received enteral feeding experienced fewer total complications (P < 0.05) and were at lower risk of developing septic complications (P < 0.01) than those receiving parenteral nutrition. The cost of nutritional support was three times higher in patients who received parenteral nutrition.
This study suggests that early enteral nutrition should be used preferentially in patients with severe acute pancreatitis.
肠外营养在为急性胰腺炎患者提供营养支持同时避免胰腺刺激方面已得到充分确立。然而，它与并发症及高成本相关。在其他疾病状态下肠内喂养的益处促使在这种临床情况下对早期肠内喂养与全肠外营养进行比较。
38例急性重症胰腺炎患者被随机分为两组。第一组（n = 18）通过鼻肠管接受含半要素饮食的肠内营养，而第二组（n = 20）通过中心静脉导管接受肠外营养。通过疾病临床病程、实验室检查结果及并发症发生率评估安全性。通过氮平衡确定疗效。计算营养支持的成本。
肠内喂养耐受性良好，对疾病病程无不良影响。与接受肠外营养的患者相比，接受肠内喂养的患者总并发症更少（P < 0.05），发生感染性并发症的风险更低（P < 0.01）。接受肠外营养的患者营养支持成本高出三倍。
本研究表明，早期肠内营养应优先用于重症急性胰腺炎患者。
