荷兰研究人员进行了一项多中心的随机试验,对比了急性胰腺炎病人急诊入院后,早期鼻饲管注入营养和72小时后经口进食的效果。研究发现在有并发症高风险的重症胰腺炎病人中,早期进行鼻饲管喂养与72小时后经口进食相比,在减少感染率或死亡率方面未见优势。

20141120日《新英格兰医学杂志》

中文译文


 

【题目】在急性胰腺炎病人中早期与按需给予鼻饲管喂养的对比

【译文】

背景:重症急性胰腺炎病人经常通过鼻饲管早期给予肠内营养,以防止肠源性感染,但支持该做法的证据有限。我们进行了一项多中心的随机试验,对比了急性胰腺炎病人急诊入院后,早期鼻饲管注入营养和72小时后经口进食的效果。

方法:我们基于“急性生理和慢性健康评估评分II”在8分或以上(分数范围0-71分,高分表示疾病严重)、Imrie或修订的Glasgow评分在3分或以上(分数范围0-8分,分数越高病情越严重)和血清C反应蛋白水平超过150mg/L,招募有出现并发症高风险的急性胰腺炎病人。病人随机分配为随机后24小时内接受鼻饲管喂养(早期组)或72小时后经口进食(按需组),如果经口进食不耐受则通过鼻饲管喂养。主要终点是在6个月随访中出现主要器官混合感染(感染性坏死性胰腺炎、菌血症或肺炎)或死亡。

结果:共有19所荷兰医院的208个病人参与研究。在早期组的101个病人中有30人(30%)发生主要终点,而按需组的104人中有28人(27%)发生(危险比1.0795%CI 0.79-1.44P=0.76)。早期组和按需组在主要感染(两组分别为25%26%P=0.87)和死亡(两组分别为11%7%P=0.33)方面无明显差异。在按需组有72人(69%)耐受经口进食而未要求鼻饲管喂养。

结论:本试验显示在有并发症高风险的重症胰腺炎病人中,早期进行鼻饲管喂养与72小时后经口进食相比,在减少感染率或死亡率方面未见优势。

 

英文原稿


 

[Title] Early versus On-Demand Nasoenteric Tube Feeding in Acute Pancreatitis

[Authors] Olaf J. Bakker, M.D., Sandra van Brunschot, M.D., Hjalmar C. van Santvoort, M.D., Ph.D., Marc G. Besselink, M.D., Ph.D., Thomas L. Bollen, M.D., Marja A. Boermeester, M.D., Ph.D., et al.

[Abstract]

BACKGROUND: Early enteral feeding through a nasoenteric feeding tube is often used in patients with severe acute pancreatitis to prevent gut-derived infections, but evidence to support this strategy is limited. We conducted a multicenter, randomized trial comparing early nasoenteric tube feeding with an oral diet at 72 hours after presentation to the emergency department in patients with acute pancreatitis.

METHODS: We enrolled patients with acute pancreatitis who were at high risk for complications on the basis of an Acute Physiology and Chronic Health Evaluation II score of 8 or higher (on a scale of 0 to 71, with higher scores indicating more severe disease), an Imrie or modified Glasgow score of 3 or higher (on a scale of 0 to 8, with higher scores indicating more severe disease), or a serum C-reactive protein level of more than 150 mg per liter. Patients were randomly assigned to nasoenteric tube feeding within 24 hours after randomization (early group) or to an oral diet initiated 72 hours after presentation (on-demand group), with tube feeding provided if the oral diet was not tolerated. The primary end point was a composite of major infection (infected pancreatic necrosis, bacteremia, or pneumonia) or death during 6 months of follow-up.

RESULTS:A total of 208 patients were enrolled at 19 Dutch hospitals. The primary end point occurred in 30 of 101 patients (30%) in the early group and in 28 of 104 (27%) in the on-demand group (risk ratio, 1.07; 95% confidence interval, 0.79 to 1.44; P=0.76). There were no significant differences between the early group and the on-demand group in the rate of major infection (25% and 26%, respectively; P=0.87) or death (11% and 7%, respectively; P=0.33). In the on-demand group, 72 patients (69%) tolerated an oral diet and did not require tube feeding.

CONCLUSIONS:This trial did not show the superiority of early nasoenteric tube feeding, as compared with an oral diet after 72 hours, in reducing the rate of infection or death in patients with acute pancreatitis at high risk for complications.

 

原文网址:

http://www.nejm.org/doi/full/10.1056/NEJMoa1404393

 

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