胰腺炎胃管课件.pptVIP

Abstract back back Definitions of the four severity categories Definitions of the four severity categories Definitions of the four severity categories New * Nasogastric or Nasojejunal Nasojejunal tube feeding is considered the current standard of care in patients with severe and critical acute pancreatitis. However, it is not known whether enteral nutrition is best delivered into the jejunum. This Commentary discusses recent clinical studies that have shown that tube feeding into the stomach is safe and well tolerated in the vast majority of patients with acute pancreatitis, thus overthrowing the notion of putting the pancreas at rest. Development of a new conceptual framework is warranted to further advance nutritional management of patients with acute pancreatitis. The study by Chang and colleagues [1] adds an important perspective to the discussion regarding the ‘pancreatic rest’ concept, which is perhaps the oldest dogma in the management of AP. The central tenet of this concept is that enteral nutrition delivered into any part of the upper gastrointestinal tract other than the jejunum stimulates pancreatic secretion and, consequently, exacerbates the severity of AP. The corollary is that ‘non-stimulatory’ nutrition had been widely advocated, being total parenteral nutrition two to three decades ago and nasojejunal tube feeding in the past decade. That is why the majority of randomised controlled trials in the past studied ‘non-stimulatory’ regimens as both intervention and comparator, that is, either parenteral nutrition versus nil peros, or parenteral nutrition versus jejunal tube feeding, or jejunal tube feeding versus nil peros [7,8]. The recent international multidisciplinary classification of AP has redefined the ‘severe’ category of severity and introduced the new ‘critical’ category of severity (Table 1), thus putting a high emphasis on the need to optimise manage ment of these most challenging patients . (Peri)pancreatic necrosis is : 1.nonviable