Chapman M, Fraser R, Finnis M, De Keulenaer B, Liberalli D, Satanek M
Intensive Care Unit, Royal Adelaide Hospital, North Terrace, SA.
Anaesth Intensive Care. 2001 Dec;29(6):619-22. doi: 10.1177/0310057X0102900611.
Nutritional support is routine practice in critically ill patients and enteral feeding is preferred to the parenteral route. However this direct delivery of nutrients to the gut is potentially ineffective for a variety of reasons. We performed a prospective audit of 40 consecutive intensive care patients to determine whether enteral feeding met the nutritional requirements of our patients. The ideal requirements for each patient were calculated using the Harris-Benedict equation with an adjustment determined by the patient's diagnosis. We compared the amount of feed delivered with the daily requirements over a seven-day period Successful feeding was defined as the achievement of 90% of the ideal calorie requirement for two consecutive days. The mean calculated (+/- SD) energy requirement was 9,566 kJ (+/- 2,586). Patients received only 51% (SD 38) of their energy requirements throughout the study period. Only 10 patients (25%) were successfully fed for at least any two-day period in the seven days. Feeding was limited mainly by gastrointestinal dysfunction or by the need to fast the patient for medical, surgical and airway procedures. Success of feeding was not related to the use of sedative orparalysing agents and had no correlation with plasma albumin concentration. There was no difference in the volume of feed delivered to patients who survived or died. Prokinetic agents were used in 25 patients and in these patients there was a trend towards improved delivery of feed.
营养支持是重症患者的常规治疗手段，肠内营养优于肠外营养。然而，由于多种原因，这种直接向肠道输送营养物质的方式可能效果不佳。我们对40例连续入住重症监护病房的患者进行了一项前瞻性审计，以确定肠内营养是否能满足患者的营养需求。使用哈里斯-本尼迪克特方程计算每位患者的理想需求量，并根据患者诊断进行调整。我们比较了七天内提供的喂养量与每日需求量。成功喂养定义为连续两天达到理想热量需求的90%。计算得出的平均（±标准差）能量需求为9566千焦（±2586）。在整个研究期间，患者仅获得了其能量需求的51%（标准差38）。在七天内，只有10名患者（25%）至少有连续两天成功喂养。喂养受限主要是由于胃肠功能障碍或因医疗、手术及气道操作需要让患者禁食。喂养成功与否与使用镇静剂或麻痹剂无关，且与血浆白蛋白浓度无相关性。存活或死亡患者所接受的喂养量没有差异。25例患者使用了促动力药物，在这些患者中，喂养量有增加的趋势。
