Pironi L, Paganelli F, Labate A M M, Merli C, Guidetti C, Spinucci G, Miglioli M
Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy.
Dig Liver Dis. 2003 May;35(5):314-24. doi: 10.1016/s1590-8658(03)00074-4.
Comparisons between safety and efficacy of home parenteral nutrition and of intestinal transplantation for treatment of chronic intestinal failure derived from observational studies.
To present the 16-year experience of home parenteral nutrition by the Chronic Intestinal Failure Centre of Bologna University.
A total of 40 adult patients were enrolled between 1986 and 2001.
Safety indices: survival and cause of death, catheter-related bloodstream infection, deep vein thrombosis, liver disease. Efficacy indices: nutritional and rehabilitation status, quality of life (SF36 instrument), re-hospitalisation rate.
Kaplan-Maier analysis and Cox model for survival probability and risk factors; logistic regression for catheter-related bloodstream infection risk factors.
Survival rates at 1, 3 and 5 years were 97, 82 and 67% respectively. Survival was higher in patients < or = 40 years. One death was home parenteral nutrition-related. Incidence of catheter-related bloodstream infection: 0.30/year home parenteral nutrition, was lower in patients treated by a specialized nursing protocol. Incidence of deep vein thrombosis was 0.05/year home parenteral nutrition. Hepatosteatosis occurred in 55%. Body weight remained stable or increased in 80%. Rehabilitation was total or partial in 74%. Re-hospitalisation rate was 0.70/year home parenteral nutrition. Quality of life scored significantly lower than in healthy populations in six out of eight domains.
Home parenteral nutrition is a safe and efficacious therapy for chronic intestinal failure. Survival compares favourably with survival after intestinal transplantation.
家庭肠外营养与肠道移植治疗慢性肠衰竭的安全性和有效性比较源于观察性研究。
介绍博洛尼亚大学慢性肠衰竭中心16年来家庭肠外营养的经验。
1986年至2001年间共纳入40例成年患者。
安全性指标：生存率和死亡原因、导管相关血流感染、深静脉血栓形成、肝病。有效性指标：营养和康复状况、生活质量（SF36量表）、再住院率。
采用Kaplan - Maier分析和Cox模型评估生存概率及危险因素；采用逻辑回归分析导管相关血流感染的危险因素。
1年、3年和5年生存率分别为97%、82%和67%。年龄≤40岁的患者生存率更高。1例死亡与家庭肠外营养相关。导管相关血流感染发生率：家庭肠外营养为0.30/年，采用专业护理方案治疗的患者发生率较低。深静脉血栓形成发生率为家庭肠外营养0.05/年。脂肪性肝病发生率为55%。80%的患者体重保持稳定或增加。74%的患者实现了全部或部分康复。家庭肠外营养的再住院率为0.70/年。在八个领域中的六个领域，生活质量得分显著低于健康人群。
家庭肠外营养是治疗慢性肠衰竭的一种安全有效的疗法。其生存率与肠道移植后的生存率相比具有优势。
