Mentec H, Dupont H, Bocchetti M, Cani P, Ponche F, Bleichner G
Intensive Care Unit, Victor Dupouy Hospital, Argenteuil, France.
Crit Care Med. 2001 Oct;29(10):1955-61. doi: 10.1097/00003246-200110000-00018.
To study the frequency of and risk factors for increased gastric aspirate volume (GAV) and upper digestive intolerance and their complications during enteral nutrition (EN) in critically ill patients.
Prospective observational study.
Intensive care unit (ICU) in a general hospital.
A total of 153 patients with nasogastric tube feeding.
None.
Upper digestive intolerance was considered when GAV was between 150 and 500 mL at two consecutive measurements, when it was >500 mL, or when vomiting occurred. Forty-nine patients (32%; 95% confidence interval [CI], 25%-42%) presented increased GAV after a median EN duration of 2 days (range, 1-16 days), and 70 patients (46%; 95% CI, 38%-54%) presented upper digestive intolerance. Independent risk factors for high GAV were GAV >20 mL before the start of EN (odds ratio [OR], 2.16; 95% CI, 1.11-4.18; p =.02), GAV >100 mL during EN (OR, 1.49; 95% CI, 1.01-2.19; p <.05), sedation during EN (OR, 1.78; 95% CI, 1.17-2.71; p =.007), use of catecholamines during EN (OR, 1.81; 95% CI, 1.21-2.70; p =.004). Complications related to high GAV were a lower feed intake (15 +/- 7 vs. 19 +/- 8 kcal/kg/day; p =.0004) and vomiting (53% vs. 23%; p =.0002). Complications related to upper digestive intolerance were the development of pneumonia (43% vs. 24%; p =.01), a longer ICU stay (23 +/- 21 vs. 15 +/- 16 days; p =.007), and a higher ICU mortality (41% vs. 25%; p =.03), even after adjustment for Simplified Acute Physiology Score II (OR, 1.48; 95% CI, 1.04-2.10; p =.028).
In ICU patients receiving nasogastric tube feeding, high gastric aspirate volume was frequent, occurred early, and was more frequent in patients with sedation or catecholamines. High gastric aspirate volume was an early marker of upper digestive intolerance, which was associated with a higher incidence of nosocomial pneumonia, a longer ICU stay, and a higher ICU mortality.
研究重症患者肠内营养（EN）期间胃内吸出物量（GAV）增加、上消化道不耐受及其并发症的发生率和危险因素。
前瞻性观察性研究。
一家综合医院的重症监护病房（ICU）。
共153例接受鼻胃管喂养的患者。
无。
当连续两次测量GAV在150至500 mL之间、GAV>500 mL或发生呕吐时，考虑存在上消化道不耐受。49例患者（32%；95%置信区间[CI]，25%-42%）在EN中位持续时间2天（范围1-16天）后出现GAV增加，70例患者（46%；95%CI，38%-54%）出现上消化道不耐受。GAV升高的独立危险因素为EN开始前GAV>20 mL（比值比[OR]，2.16；95%CI，1.11-4.18；p = 0.02）、EN期间GAV>100 mL（OR，1.49；95%CI，1.01-2.19；p<0.05）、EN期间使用镇静剂（OR，1.78；95%CI，1.17-2.71；p = 0.007）、EN期间使用儿茶酚胺（OR，1.81；95%CI，1.21-2.70；p = 0.004）。与高GAV相关的并发症为喂养摄入量降低（15±7 vs. 19±8 kcal/kg/天；p = 0.0004）和呕吐（53% vs. 23%；p = 0.0002）。与上消化道不耐受相关的并发症为肺炎发生率增加（43% vs. 24%；p = 0.01）、ICU住院时间延长（23±21 vs. 15±16天；p = 0.007）和ICU死亡率升高（41% vs. 25%；p = 0.03），即使在调整简化急性生理学评分II后也是如此（OR，1.48；95%CI，1.04-2.10；p = 0.028）。
在接受鼻胃管喂养的ICU患者中，高胃内吸出物量很常见，出现较早，在使用镇静剂或儿茶酚胺的患者中更频繁。高胃内吸出物量是上消化道不耐受的早期标志，与医院获得性肺炎发生率升高、ICU住院时间延长和ICU死亡率升高相关。
