A randomized controlled trial of enteral versus parenteral feeding in patients with predicted severe acute pancreatitis shows a significant reduction in mortality and in infected pancreatic complications with total enteral nutrition

被引:176
作者
Petrov, Maxim S. [1 ]
Kukosh, Mikhail V. [1 ]
Emelyanov, Nikolay V. [1 ]
机构
[1] Nizhny Novgorod State Med Acad, Dept Surg, Nizhnii Novgorod, Russia
关键词
enteral nutrition; parenteral nutrition; acute pancreatitis; infections; mortality;
D O I
10.1159/000097949
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: Infectious complications are the main cause of late death in patients with acute pancreatitis. Routine prophylactic antibiotic use following a severe attack has been proposed but remains controversial. On the other hand, nutritional support has recently yielded promising clinical results. The aim of study was to compare enteral vs. parenteral feeding for prevention of infectious complications in patients with predicted severe acute pancreatitis. Methods: We screened 466 consecutive patients with acute pancreatitis. A total of 70 patients with objectively graded severe acute pancreatitis were randomly allocated to receive either total enteral nutrition ( TEN) or total parenteral nutrition ( TPN), within 72 h of onset of symptoms. Baseline characteristics were well matched in the two groups. Results: The incidence of pancreatic infectious complications ( infected pancreatic necrosis, pancreatic abscess) was significantly lower in the enterally fed group ( 7 vs. 16, p = 0.02). In the TEN group, 7 patients developed multiple organ failure whereas 17 parenterally fed patients developed multiple organ failure ( p = 0.02). Overall mortality was 20% with two deaths in the TEN group and twelve in the TPN group ( p < 0.01). Conclusion: Early TEN could be used as prophylactic therapy for infected pancreatic necrosis since it significantly decreased the incidence of pancreatic infectious complications as well as the frequency of multiple organ failure and mortality. Copyright (c) 2006 S. Karger AG, Basel.
引用
收藏
页码:336 / 344
页数:9
相关论文
共 46 条
[1]  
Abou-Assi S, 2002, AM J GASTROENTEROL, V97, P2255, DOI 10.1111/j.1572-0241.2002.05979.x
[2]   Early increase in intestinal permeability in patients with severe acute pancreatitis: Correlation with endotoxemia, organ failure, and mortality [J].
Ammori, BJ ;
Leeder, PC ;
King, RFGJ ;
Barclay, GR ;
Martin, IG ;
Larvin, M ;
McMahon, MJ .
JOURNAL OF GASTROINTESTINAL SURGERY, 1999, 3 (03) :252-261
[3]  
ANDRENSANDBERG A, 2002, J PANCREAS, V3, P116
[4]  
Banks PA, 1995, INT J PANCREATOL, V18, P265
[5]   Current concepts - Acute necrotizing pancreatitis [J].
Baron, TH ;
Morgan, DE .
NEW ENGLAND JOURNAL OF MEDICINE, 1999, 340 (18) :1412-1417
[6]   BACTERIAL-CONTAMINATION OF PANCREATIC NECROSIS - A PROSPECTIVE CLINICAL-STUDY [J].
BEGER, HG ;
BITTNER, R ;
BLOCK, S ;
BUCHLER, M .
GASTROENTEROLOGY, 1986, 91 (02) :433-438
[7]  
Braunschweig CL, 2001, AM J CLIN NUTR, V74, P534
[8]  
Büchler MW, 2000, ANN SURG, V232, P619
[9]  
BUCHMAN AL, 1995, JPEN J PARENTER ENTE, P453
[10]  
CANO N, 2004, CRIT CARE SHOCK, V7, P69