基于病人饥饿的早期经口进食对轻症急性胰腺炎临床结局的影响

Effect of early on-demand oral feeding based on hunger on clinical outcomes in patients with mild acute pancreatitis

目的:通过对91例入院考虑诊断轻症急性胰腺炎(MAP)的病人分别实施病人主导基于饥饿的早期经口进食(PDS-EOFH)和医生主导的传统经口进食(DDS-COF),旨在探讨这两种不同的经口进食标准对MAP病人临床结局的影响。方法:选取2018年1月至2018年12月我院消化科收治符合条件的MAP病人为研究对象,随机分为两组,即PDS-EOFH组(病人出现饥饿感时开始经口进食),DDS-COF组(病人腹痛减轻或消失、肠鸣音恢复以及血清淀粉酶下降至接近正常时开始经口进食),比较两组间主要临床观察指标(发病至开始经口进食时间和住院时间)和次要临床观察指标(进食后腹痛腹胀复发率、血清生化学指标以及局部并发症发生率)的差异。结果:两组病人的基本情况具有可比性。与DDS-COF组相比,PDS-EOFH组发病至开始经口进食的平均时间明显提前,平均住院时间明显缩短,差异有统计学意义(P<0.05);经口进食后,两组腹痛腹胀复发率、血清淀粉酶≥3ULM例数、白细胞数及血浆白蛋白均无明显差异(P>0.05)。两组均无局部并发症发生。结论:PDS-EOFH有利于MAP病情快速恢复,是一种安全、有效的早期营养支持方案。

Objective:In order to investigate the effect of two different approache for oral feeding on the clinical outcomes of patients with mild acute pancreatitis(MAP)Methods:Eligible patients with MAP admitted to the department of gastroenterology in our hospital from January 2018 to December 2018 were randomized to either PDSEOFH group or DDS-COF group.Patients in the PDS-EOFH group started oral feeding once they reported hunger.Those in the DDS-COF group started oral feeding until they fulfilled the following criteria:①relief of abdominal symptoms and signs;②recovery of bowel sound;③reduction to normal of serum amylase.Clinical outcomes were compared between the two groups.The primary clinical observation indicators were time interval between disease onset to start of oral feeding and length of hospitalization.Secondary outcomes were relapse of pain or abdominal distension,serum biochemical indexes levels and incidence of local complications after oral feeding.Results:The two groups had similar baseline characteristics.Compared with DDS-COF group,the time interval between disease onset to initiation of oral feeding and length of hospitalization were significantly shorter in the PDS-EOFH group,with statistically significant differences(P<0.05).There were no differences in relapse of pain or abdominal distension,serum amylase higher than the 3-fold higer than the upper limit measure(ULM),white blood cell count and serum albumin after oral refeeding between these 2 groups(P>0.05).There were no local complication in two groups.Conclusion:PDS-EOFH is a safe and effective early nutritional support strategy for rapid recovery of MAP.