Summary of best evidence for early enteral nutrition in patients with severe acute pancreatitis_West China Medical Journal

Authors：

CAO Keyu ¹ ,  GONG Shu ^1,2 , CHENG Jingxia ^1,3

1. West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Division of Pancreatic Surgery , Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

GONG Shu, Email: gdy-29@163.com

Keywords：

Severe acute pancreatitis; enteral nutrition; nutritional support; evidence based nursing; summary of evidence

DOI：

10.7507/1002-0179.202412012

Video：

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Objective To evaluate and summarize the relevant evidence of early enteral nutrition in patients with severe acute pancreatitis (SAP), and provide evidence-based support for the clinical practice of early enteral nutrition in SAP patients. Methods The evidence on early enteral nutrition in SAP patients from relevant databases and websites was retrieved using computer. The retrieval deadline was from the establishment of the databases to December 31, 2024. Two researchers independently conducted literature screening and quality evaluation, extracted and summarized evidence. Results A total of 14 articles were included, including 6 systematic reviews, 7 guidelines, and 1 expert consensus. A total of 19 pieces of evidence were compiled and summarized from 9 aspects, including early enteral nutrition feeding assessment, start timing, feeding route, catheterization method, infusion method and speed, energy and protein targets, nutrient preparation selection, complication prevention and management, and health education. Conclusion The overall quality of evidence for early enteral nutrition in SAP patients is good and has strong generalizability. Medical staff should select evidence based on clinical contexts and develop safe, scientific, and personalized enteral nutrition plans for patients to promote their recovery.

1.	Yasuda H, Horibe M, Sanui M, et al. Etiology and mortality in severe acute pancreatitis: a multicenter study in Japan. Pancreatology, 2020, 20(3): 307-317.
2.	芦波, 钱家鸣. 重症急性胰腺炎病因及发病机制研究进展. 中国实用外科杂志, 2012, 32(7): 590-592.
3.	中华医学会急诊分会, 京津冀急诊急救联盟, 北京医学会急诊分会, 等. 急性胰腺炎急诊诊断及治疗专家共识. 临床肝胆病杂志, 2021, 37(5): 1034-1041.
4.	谢蕾, 刘航, 申洋, 等. 重症急性胰腺炎并发感染的危险因素及对机体免疫水平的影响. 中华胰腺病杂志, 2020, 20(4): 283-287.
5.	王倩倩, 周健, 江志伟, 等. 抑胰合剂联合早期肠内营养对重症急性胰腺炎肠黏膜屏障及并发症的影响. 中华中医药杂志, 2023, 38(3): 1370-1374.
6.	Wu XM, Ji KQ, Wang HY, et al. Total enteral nutrition in prevention of pancreatic necrotic infection in severe acute pancreatitis. Pancreas, 2010, 39(2): 248-251.
7.	蔡雪军, 邵建平, 李永元, 等. 重症急性胰腺炎早期肠内营养对肠源性感染指标的影响. 中华医院感染学杂志, 2019, 29(1): 99-101, 105.
8.	Arvanitakis M, Ockenga J, Bezmarevic M, et al. ESPEN guideline on clinical nutrition in acute and chronic pancreatitis. Clin Nutr, 2020, 39(3): 612-631.
9.	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成. 护士进修杂志, 2017, 32(21): 1991-1994.
10.	Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ, 2010, 182(18): E839-E842.
11.	Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 2017, 358: j4008.
12.	周英凤, 顾莺, 胡雁, 等. JBI 循证卫生保健中心关于不同类型研究的质量评价工具——干预性研究的质量评价. 护士进修杂志, 2018, 33(1): 24-26.
13.	王春青, 胡雁. JBI 证据预分级及证据推荐级别系统(2014 版). 护士进修杂志, 2015(11): 964-967.
14.	崔熙娟, 李小妹, 乔丽娜, 等. 早期肠内营养促进重症急性胰腺炎预后效果的系统评价. 护理管理杂志, 2013, 13(8): 536-538.
15.	吴奇云, 程念开, 蒋玲, 等. 早期肠内营养对重症急性胰腺炎患者影响的系统评价. 护理学杂志, 2015, 30(22): 91-94.
16.	Jiang X, Pei LY, Guo WX, et al. Glutamine supported early enteral therapy for severe acute pancreatitis: a systematic review and meta-analysis. Asia Pac J Clin Nutr, 2020, 29(2): 253-261.
17.	Qi D, Yu B, Huang J, et al. Meta-analysis of early enteral nutrition provided within 24 hours of admission on clinical outcomes in acute pancreatitis. JPEN J Parenter Enteral Nutr, 2018, 42(7): 1139-1147.
18.	Chen X, Yang K, Jing G, et al. Meta-analysis of efficacy of rhubarb combined with early enteral nutrition for the treatment of severe acute pancreatitis. JPEN J Parenter Enteral Nutr, 2020, 44(6): 1066-1078.
19.	Gao Z, Yin S, Jin K, et al. Effectiveness and safety of probiotics on patients with severe acute pancreatitis: a systematic review and meta-analysis. Medicine (Baltimore), 2023, 102(50): e36454.
20.	中华医学会外科学分会胰腺外科学组. 中国急性胰腺炎诊治指南(2021). 中华外科杂志, 2021, 59(7): 578-587.
21.	中国中西医结合学会, 中华中医药学会, 中华医学会. 急性胰腺炎中西医结合诊疗指南. 北京: 中国中西医结合学会, 2023.
22.	Reintam Blaser A, Starkopf J, Alhazzani W, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med, 2017, 43(3): 380-398.
23.	Takada T, Isaji S, Mayumi T, et al. JPN clinical practice guidelines 2021 with easy-to-understand explanations for the management of acute pancreatitis. J Hepatobiliary Pancreat Sci, 2022, 29(10): 1057-1083.
24.	National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis and management of physical complications. London: National Institute for Health and Care Excellence, 2017.
25.	National Institute for Health and Care Excellence. Pancreatitis. London: National Institute for Health and Care Excellence, 2020.
26.	Bordejé Laguna L, Lorencio Cárdenas C, Acosta Escribano J, et al. Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: severe acute pancreatitis. Nutr Hosp, 2011, 26(Suppl 2): 32-36.
27.	中国急诊危重症患者肠内营养治疗专家共识组. 中国急诊危重症患者肠内营养治疗专家共识. 中华急诊医学杂志, 2022, 31(3): 281-290.
28.	Kondrup J, Allison SP, Elia M, et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr, 2003, 22(4): 415-421.
29.	谢洁莹, 周望梅, 徐慧颖, 等. 急性胰腺炎患者早期肠内营养最佳证据总结. 护理学报, 2020, 27(19): 29-34.
30.	李凤丹, 胡慧芳, 都继微. 急性胰腺炎患者早期肠内营养支持的证据总结. 中国护理管理, 2020, 20(7): 1055-1061.
31.	向圣晓, 谢萍, 蔡奉娟, 等. 超早期肠内营养治疗重症急性胰腺炎的 meta 分析. 国际医药卫生导报, 2021, 27(9): 1354-1360.
32.	中华医学会外科学分会胰腺外科学组. 中国急性胰腺炎诊治指南(2021). 浙江实用医学, 2021, 26(6): 511-519,535.
33.	Li Y, Ye Y, Mei Y, et al. Semi-automated ultrasound guidance applied to nasogastrojejunal tube replacement for enteral nutrition in critically ill adults. Biomed Eng Online, 2018, 17(1): 21.
34.	Foote JA, Kemmeter PR, Prichard PA, et al. A randomized trial of endoscopic and fluoroscopic placement of postpyloric feeding tubes in critically ill patients. JPEN J Parenter Enteral Nutr, 2004, 28(3): 154-157.
35.	McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr, 2016, 40(2): 159-211.
36.	陈丽, 袁慧, 李菊芳, 等. 肠内营养相关并发症预防与管理最佳证据总结. 肠外与肠内营养, 2021, 28(2): 109-116.
37.	张贝, 李瑶, 刘云访, 等. 成人急性胰腺炎患者喂养管管理的证据总结. 护理学杂志, 2021, 36(24): 42-45,59.
38.	Boullata JI, Carrera AL, Harvey L, et al. ASPEN safe practices for enteral nutrition therapy [formula: see text]. JPEN J Parenter Enteral Nutr, 2017, 41(1): 15-103.
39.	陈丽花, 盛青青, 黄瑶, 等. 重症患者腹内高压预防与管理的最佳证据总结. 中华护理杂志, 2022, 57(17): 2164-2170.
40.	Hollemans RA, Hallensleben NDL, Mager DJ, et al. Pancreatic exocrine insufficiency following acute pancreatitis: systematic review and study level meta-analysis. Pancreatology, 2018, 18(3): 253-262.

1. Yasuda H, Horibe M, Sanui M, et al. Etiology and mortality in severe acute pancreatitis: a multicenter study in Japan. Pancreatology, 2020, 20(3): 307-317.
2. 芦波, 钱家鸣. 重症急性胰腺炎病因及发病机制研究进展. 中国实用外科杂志, 2012, 32(7): 590-592.
3. 中华医学会急诊分会, 京津冀急诊急救联盟, 北京医学会急诊分会, 等. 急性胰腺炎急诊诊断及治疗专家共识. 临床肝胆病杂志, 2021, 37(5): 1034-1041.
4. 谢蕾, 刘航, 申洋, 等. 重症急性胰腺炎并发感染的危险因素及对机体免疫水平的影响. 中华胰腺病杂志, 2020, 20(4): 283-287.
5. 王倩倩, 周健, 江志伟, 等. 抑胰合剂联合早期肠内营养对重症急性胰腺炎肠黏膜屏障及并发症的影响. 中华中医药杂志, 2023, 38(3): 1370-1374.
6. Wu XM, Ji KQ, Wang HY, et al. Total enteral nutrition in prevention of pancreatic necrotic infection in severe acute pancreatitis. Pancreas, 2010, 39(2): 248-251.
7. 蔡雪军, 邵建平, 李永元, 等. 重症急性胰腺炎早期肠内营养对肠源性感染指标的影响. 中华医院感染学杂志, 2019, 29(1): 99-101, 105.
8. Arvanitakis M, Ockenga J, Bezmarevic M, et al. ESPEN guideline on clinical nutrition in acute and chronic pancreatitis. Clin Nutr, 2020, 39(3): 612-631.
9. 朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成. 护士进修杂志, 2017, 32(21): 1991-1994.
10. Brouwers MC, Kho ME, Browman GP, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ, 2010, 182(18): E839-E842.
11. Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 2017, 358: j4008.
12. 周英凤, 顾莺, 胡雁, 等. JBI 循证卫生保健中心关于不同类型研究的质量评价工具——干预性研究的质量评价. 护士进修杂志, 2018, 33(1): 24-26.
13. 王春青, 胡雁. JBI 证据预分级及证据推荐级别系统(2014 版). 护士进修杂志, 2015(11): 964-967.
14. 崔熙娟, 李小妹, 乔丽娜, 等. 早期肠内营养促进重症急性胰腺炎预后效果的系统评价. 护理管理杂志, 2013, 13(8): 536-538.
15. 吴奇云, 程念开, 蒋玲, 等. 早期肠内营养对重症急性胰腺炎患者影响的系统评价. 护理学杂志, 2015, 30(22): 91-94.
16. Jiang X, Pei LY, Guo WX, et al. Glutamine supported early enteral therapy for severe acute pancreatitis: a systematic review and meta-analysis. Asia Pac J Clin Nutr, 2020, 29(2): 253-261.
17. Qi D, Yu B, Huang J, et al. Meta-analysis of early enteral nutrition provided within 24 hours of admission on clinical outcomes in acute pancreatitis. JPEN J Parenter Enteral Nutr, 2018, 42(7): 1139-1147.
18. Chen X, Yang K, Jing G, et al. Meta-analysis of efficacy of rhubarb combined with early enteral nutrition for the treatment of severe acute pancreatitis. JPEN J Parenter Enteral Nutr, 2020, 44(6): 1066-1078.
19. Gao Z, Yin S, Jin K, et al. Effectiveness and safety of probiotics on patients with severe acute pancreatitis: a systematic review and meta-analysis. Medicine (Baltimore), 2023, 102(50): e36454.
20. 中华医学会外科学分会胰腺外科学组. 中国急性胰腺炎诊治指南(2021). 中华外科杂志, 2021, 59(7): 578-587.
21. 中国中西医结合学会, 中华中医药学会, 中华医学会. 急性胰腺炎中西医结合诊疗指南. 北京: 中国中西医结合学会, 2023.
22. Reintam Blaser A, Starkopf J, Alhazzani W, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med, 2017, 43(3): 380-398.
23. Takada T, Isaji S, Mayumi T, et al. JPN clinical practice guidelines 2021 with easy-to-understand explanations for the management of acute pancreatitis. J Hepatobiliary Pancreat Sci, 2022, 29(10): 1057-1083.
24. National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis and management of physical complications. London: National Institute for Health and Care Excellence, 2017.
25. National Institute for Health and Care Excellence. Pancreatitis. London: National Institute for Health and Care Excellence, 2020.
26. Bordejé Laguna L, Lorencio Cárdenas C, Acosta Escribano J, et al. Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: severe acute pancreatitis. Nutr Hosp, 2011, 26(Suppl 2): 32-36.
27. 中国急诊危重症患者肠内营养治疗专家共识组. 中国急诊危重症患者肠内营养治疗专家共识. 中华急诊医学杂志, 2022, 31(3): 281-290.
28. Kondrup J, Allison SP, Elia M, et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr, 2003, 22(4): 415-421.
29. 谢洁莹, 周望梅, 徐慧颖, 等. 急性胰腺炎患者早期肠内营养最佳证据总结. 护理学报, 2020, 27(19): 29-34.
30. 李凤丹, 胡慧芳, 都继微. 急性胰腺炎患者早期肠内营养支持的证据总结. 中国护理管理, 2020, 20(7): 1055-1061.
31. 向圣晓, 谢萍, 蔡奉娟, 等. 超早期肠内营养治疗重症急性胰腺炎的 meta 分析. 国际医药卫生导报, 2021, 27(9): 1354-1360.
32. 中华医学会外科学分会胰腺外科学组. 中国急性胰腺炎诊治指南(2021). 浙江实用医学, 2021, 26(6): 511-519,535.
33. Li Y, Ye Y, Mei Y, et al. Semi-automated ultrasound guidance applied to nasogastrojejunal tube replacement for enteral nutrition in critically ill adults. Biomed Eng Online, 2018, 17(1): 21.
34. Foote JA, Kemmeter PR, Prichard PA, et al. A randomized trial of endoscopic and fluoroscopic placement of postpyloric feeding tubes in critically ill patients. JPEN J Parenter Enteral Nutr, 2004, 28(3): 154-157.
35. McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr, 2016, 40(2): 159-211.
36. 陈丽, 袁慧, 李菊芳, 等. 肠内营养相关并发症预防与管理最佳证据总结. 肠外与肠内营养, 2021, 28(2): 109-116.
37. 张贝, 李瑶, 刘云访, 等. 成人急性胰腺炎患者喂养管管理的证据总结. 护理学杂志, 2021, 36(24): 42-45,59.
38. Boullata JI, Carrera AL, Harvey L, et al. ASPEN safe practices for enteral nutrition therapy [formula: see text]. JPEN J Parenter Enteral Nutr, 2017, 41(1): 15-103.
39. 陈丽花, 盛青青, 黄瑶, 等. 重症患者腹内高压预防与管理的最佳证据总结. 中华护理杂志, 2022, 57(17): 2164-2170.
40. Hollemans RA, Hallensleben NDL, Mager DJ, et al. Pancreatic exocrine insufficiency following acute pancreatitis: systematic review and study level meta-analysis. Pancreatology, 2018, 18(3): 253-262.

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