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2016年3月24日，美国麻省（马萨诸塞州）医学会官方期刊《新英格兰医学杂志》（NEJM）正式发表了比利时鲁汶大学医院、荷兰伊拉斯谟大学医学中心索菲亚儿童医院、加拿大阿尔伯塔大学斯托雷儿童医院的国际多中心随机对照研究报告：重症儿童的早期与推迟肠外营养（PEPaNIC）。 在同期杂志上，美国哈佛医学院麻醉学副教授、波士顿儿童医院内外科重症监护病房内科副主任、重症医学科副主任、重症营养科主任奈尔什·梅塔（Nilesh M. Mehta）对该研究进行了详细介绍，强调在理想情况下重症儿童营养疗法必须个体化（因人而异）。统一方法用于所有患者过于简单化。根据PEPaNIC研究结果，推迟肠外营养、早期开始并逐步递增肠内营养，对于非严重营养不良患者似乎是谨慎明智的。通过随机对照试验，需要耐心和大量资源以系统地解决尚未解决的问题。由于证据正在逐渐完善，必须对研究结果进行谨慎解读，致力于机理和假设产生的研究，并探讨相关长期结局。PEPaNIC研究代表了重要的一步，其结果将有助于重新调整肠外营养安全用于重症儿童。 N Engl J Med. 2016 Mar 24;374(12):1190-2. Parenteral Nutrition in Critically Ill Children. Mehta NM. Harvard Medical School and the Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital - both in Boston. Ideally, nutrition therapy for critically ill children must be individualized. The presupposition that a uniform approach would apply to all is too simplistic. On the basis of the results of the PEPaNIC trial, delaying parenteral nutrition, along with early initiation and stepwise advancement of enteral nutrition, seems prudent in patients who are not severely malnourished. Patience and substantial resources will be required to systematically address unresolved questions through randomized, controlled trials. As the tapestry of evidence is gradually woven, we must be circumspect in our interpretation of study results, invest in mechanistic and hypothesis-generating studies, and explore relevant long-term outcomes. The PEPaNIC trial represents an important step forward, and its results will help to recalibrate the safe application of parenteral nutrition in critically ill children. COMMENT ON: Early versus Late Parenteral Nutrition in Critically Ill Children. N Engl J Med. 2016 Mar 24;374(12):1111-22. PMID: 26975731 DOI: 10.1056/NEJMe1601140 |
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