Feeding and Pancreatic Rest in Acute Pancreatitis

重症急性胰腺炎(SAP)是一种死亡率高(20%-30%)的疾病，与长期 住院和过高的费用。尽管我们在理解上取得了重大进展 对于疾病的病理生理学，治疗仍是支持性的。管理的中坚力量是营养 支持，因为代谢支出过高，患者不能长时间进食。 因为担心刺激受损的胰腺会加剧疾病的进程，这是 以胰腺内胰酶原过早激活为特征，这是 治疗方法是胰腺休息加静脉喂养(TPN)，以避免胰腺刺激。 然而，TPN的感染和代谢并发症已被证明超过了它的好处，并且 几项前瞻性随机比较试验表明，患者的预后甚至更好。 幽门后肠内喂养，这是刺激的。此外，最近的两项研究也进行了合作 在其他危重患者群体中的研究表明，鼻胃(NG)喂养半元素 饮食与幽门后喂养一样有效，而且不会增加 尽管已知胃排空障碍，但仍有误吸的风险。这导致了建议NG 饲喂应该优先使用，因为它不需要专家来开始和做。人们的担忧依然存在 死亡率没有提高，这引发了一个问题，即喂食NG是否比不喂食更好 喂食。然而，不喂食在SAP中不是一种选择，因为非相反的蛋白质分解代谢会导致生命危险 2周内出现蛋白质缺乏症。我们的探索性研究表明，喂食可能会 通过在空肠中段(空肠后40 cm)放置专门的双腔喂养管进行优化 Treitz韧带)，通过鼻内窥镜技术绕过受压的上Gl束，避免 胰腺刺激，以及刺激回肠刹车--实验表明，回肠刹车可以抑制 急性胰腺炎。因此，在拟议的研究中，我们计划测试假设，与 简单的NG喂养，巧妙地放置DJ饲养管系统加速了疾病的解决，因为 它在提供营养方面更有效，不会加剧疾病过程，从而导致 降低发病率、死亡率和医院费用。招募足够的患者(n=114)以满足我们的统计数据 在合理的时间段(5年)内计算电力，我们已经组成了一个由8家领先的财团组成的联合体 国家中心进行多中心临床试验，以实现我们的目标。

Severe acute pancreatitis (SAP) is a disease of high (20-30%) mortality associated with prolonged hospitalization and excessive costs. Despite the major advances in our understanding of the pathophysiology of the disease, treatment remains supportive. The backbone of management is nutritional support as metabolic expenditure is excessively high and patients cannot eat for extended lengths of time . Because of concern that stimulation of the injured pancreas would exacerbate the disease process which is characterized by the premature activation of trypsinogen within the pancreas, the cornerstone of management has been pancreatic rest with intravenous feeding (TPN) which avoids pancreatic stimulation. However, the infective and metabolic complications of TPN have been shown to outweigh its benefits, and several prospective randomized comparative trials have demonstrated that patient outcome is better even with post-pyloric enteral feeding, which is stimulatory. Furthermore, 2 recent studies have collaborated studies in other populations of critically ill patients, showing that nasogastric (NG) feeding with a semielemental diet is as effective as post-pyloric feeding with the same dietary formula and does not increase the risk of aspiration despite the known impairmrnt of gastric emptying. This led to the recommendation that NG feeding should be used preferentially as it does not require expertize to start and to do. The concern remains that the mortality rate was not improved, raising the question whether NG feeding was better than no feeding. However, no feeding is not an option in SAP as unopposed protein catabolism would result in lifethreatening protein deficiency within 2 weeks. Exploratory studies of ours have suggested that feeding could be optimized by the placement of specialized double-lumen feeding tubes in the mid-jejunum (40cm past the ligament of Treitz) by transnasal endsocopic techniques to bypass the compressed upper Gl tract, to avoid pancreatic stimulation, and to stimulate the ileal brake - which experimentally has been shown to suppress acute pancreatitis. In the proposed study, we therefore plan to test the hypothesis that in comparison to simple NG feeding, skilled placement of DJ feeding tube systems hastens the resolution of disease because it is more effective in providing nutrition and does not exacerbate the disease process, thus leading to reduced morbidity, mortality and hospital costs. To recruit sufficient patients (n=114) to satisfy our statistical power calculations in a reasonable time period (5 years), we have formed a consortium with 8 leading national centers to conduct a multicenter clinical trial to achieve our goal.