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， 住院和过高的费用。尽管我们在理解上取得了重大进展， 疾病的病理生理学，治疗仍然支持。管理的支柱是营养 由于代谢消耗过高，患者不能长时间进食，因此需要提供支持。 因为担心刺激受损的胰腺会加剧疾病的进程， 其特征在于胰腺内胰蛋白酶原的过早激活，胰蛋白酶原是胰腺炎的基石， 管理方法是胰腺休息，静脉营养（TPN），避免胰腺刺激。 然而，TPN的感染和代谢并发症已被证明超过其益处， 几项前瞻性随机比较试验表明， 幽门后肠内营养是刺激性的此外，最近的两项研究合作 在其他危重患者人群中的研究表明，用半元素鼻饲（NG） 饮食是有效的幽门后喂养相同的饮食配方，并没有增加 尽管已知胃排空受损，但仍存在误吸风险。这导致了建议，即NG 应该优先使用喂食，因为它不需要专家来开始和做。人们的担忧依然存在 死亡率并没有得到改善，这就提出了一个问题，即NG喂养是否比不喂养更好。 喂食然而，在SAP中不喂养不是一种选择，因为无对抗性蛋白质催化剂会导致危及生命的 2周内蛋白质缺乏我们的探索性研究表明， 通过在空肠中段放置专门的双腔饲管（超过空肠40 cm）进行优化。 Treitz韧带），以绕过受压的上胃肠道， 胰腺刺激，并刺激回肠制动-这已被实验证明，抑制 急性胰腺炎因此，在拟议的研究中，我们计划检验以下假设： 简单的NG喂养，DJ喂养管系统的熟练放置加速了疾病的解决， 它在提供营养方面更有效，不会加剧疾病进程，从而导致 降低发病率、死亡率和住院费用。招募足够的患者（n=114），以满足我们的统计学要求 在合理的时间段内（5年），我们已经形成了一个由8个领先的财团 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.