Montecalvo M A, Steger K A, Farber H W, Smith B F, Dennis R C, Fitzpatrick G F, Pollack S D, Korsberg T Z, Birkett D H, Hirsch E F
Department of Medicine, Boston University School of Medicine, MA.
Crit Care Med. 1992 Oct;20(10):1377-87. doi: 10.1097/00003246-199210000-00004.
To compare nutritional status, gastric colonization, and rates of nosocomial pneumonia in ICU patients randomized to gastric tube feeding vs. patients fed by an endoscopically placed jejunal tube.
Randomized, prospective study.
Medical and surgical ICUs at Boston City Hospital; surgical ICU at University Hospital.
Of the 38 study patients, 19 were randomized to gastric tube feeding and 19 were randomized to an endoscopically placed jejunal tube. The two groups were similar in age, sex, race, underlying disease, and type of surgery.
The two patient groups were similar in number of days fed, duration of ICU stay, duration of mechanical ventilation, days of antibiotic therapy, and days with fever. Compared with the gastric group, the jejunal group had more patients with circulatory shock on admission (79% vs. 68.4%), higher admission Acute Physiology Score (24.0 vs. 21.7), and fewer patients with pneumonia at randomization (26.3% vs. 31.6%). The jejunal group received a significantly higher percentage of their daily goal caloric intake (p = .05), and had greater increases in serum prealbumin concentrations (p < .05) than the patients with gastric tube feeding. Although the jejunal tube group had more days of diarrhea (3.3 +/- 6.6 vs. 1.8 +/- 2.9), this difference was not statistically significant. Nosocomial pneumonia was diagnosed clinically in two (10.5%) patients in the gastric tube group and in no patients in the jejunal tube group.
Patients fed by jejunal tube received a significantly higher proportion of their daily goal caloric intake, had a significantly greater increase in serum prealbumin concentrations, and had a lower rate of pneumonia than patients fed by continuous gastric tube feeding.
比较随机接受胃管喂养的重症监护病房（ICU）患者与经内镜放置空肠管喂养的患者的营养状况、胃内定植情况及医院获得性肺炎的发生率。
随机前瞻性研究。
波士顿市医院的内科和外科重症监护病房；大学医院的外科重症监护病房。
38名研究患者中，19名随机接受胃管喂养，19名随机接受经内镜放置空肠管喂养。两组在年龄、性别、种族、基础疾病和手术类型方面相似。
两组患者在喂养天数、ICU住院时间、机械通气时间、抗生素治疗天数和发热天数方面相似。与胃管组相比，空肠组入院时循环休克患者更多（79%对68.4%），入院时急性生理评分更高（24.0对21.7），随机分组时肺炎患者更少（26.3%对31.6%）。空肠组每日目标热量摄入的百分比显著更高（p = 0.05），血清前白蛋白浓度的升高幅度也大于胃管喂养患者（p < 0.05）。尽管空肠管组腹泻天数更多（3.3±6.6对1.8±2.9），但这种差异无统计学意义。胃管组有2名（10.5%）患者临床诊断为医院获得性肺炎，空肠管组无患者发生。
与持续胃管喂养患者相比，空肠管喂养患者每日目标热量摄入的比例显著更高，血清前白蛋白浓度升高幅度显著更大，肺炎发生率更低。
