Meert Kathleen L, Daphtary Kshama M, Metheny Norma A
Critical Care Medicine, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA.
Chest. 2004 Sep;126(3):872-8. doi: 10.1378/chest.126.3.872.
To determine the effect of feeding tube position (gastric vs small bowel) on adequacy of nutrient delivery and feeding complications, including microaspiration, in critically ill children.
Randomized controlled trial.
Pediatric ICU in a university teaching hospital.
Seventy-four critically ill patients < 18 years of age receiving mechanical ventilation were randomized to receive gastric or small-bowel feeding.
All feeding tubes were inserted at the bedside. Color, pH, and bilirubin concentration of the feeding tube aspirates were used to guide placement. Final tube position was confirmed radiographically. Continuous feedings were advanced to achieve a caloric goal based on age and body weight. Tracheal secretions were collected daily and tested for gastric pepsin by immunoassay.
Thirty-two patients were randomized to the gastric group, and 42 patients were randomized to the small-bowel group. Twelve patients exited the study because a small-bowel tube could not be placed at the bedside, leaving 30 patients in the small-bowel group. Gastric and small-bowel groups were similar at baseline in age, sex, percentage of ideal body weight, serum prealbumin concentration, and pediatric risk of mortality score. The percentage of daily caloric goal achieved was less in the gastric group compared to the small-bowel group (30 +/- 23% vs 47 +/- 22%, p < 0.01). No difference was found in the proportion of tracheal aspirates positive for pepsin between the gastric and small-bowel groups (50 of 146 aspirates vs 50 of 172 aspirates, respectively; p = 0.3). No differences were found in the frequency of feeding tube displacement, abdominal distension, vomiting, or diarrhea between groups.
Small-bowel feeds allow a greater amount of nutrition to be successfully delivered to critically ill children. Small-bowel feeds do not prevent aspiration of gastric contents.
确定喂养管位置（胃内与小肠内）对危重症儿童营养输送充足性及喂养并发症（包括微量误吸）的影响。
随机对照试验。
一所大学教学医院的儿科重症监护病房。
74名年龄小于18岁接受机械通气的危重症患者被随机分为接受胃内喂养或小肠内喂养。
所有喂养管均在床边插入。通过喂养管吸出物的颜色、pH值和胆红素浓度来指导放置。最终管位置通过影像学确认。根据年龄和体重推进持续喂养以达到热量目标。每天收集气管分泌物并通过免疫测定法检测胃蛋白酶。
32名患者被随机分入胃内喂养组，42名患者被随机分入小肠内喂养组。12名患者退出研究，原因是无法在床边放置小肠管，小肠内喂养组剩余30名患者。胃内喂养组和小肠内喂养组在基线时的年龄、性别、理想体重百分比、血清前白蛋白浓度及儿科死亡风险评分相似。与小肠内喂养组相比，胃内喂养组达到每日热量目标的百分比更低（分别为30±23% 对47±22%，p<0.01）。胃内喂养组和小肠内喂养组气管吸出物中胃蛋白酶阳性比例无差异（分别为146份吸出物中的50份对172份吸出物中的50份；p = 0.3）。两组之间在喂养管移位、腹胀、呕吐或腹泻的频率上未发现差异。
小肠内喂养能成功地为危重症儿童输送更多营养。小肠内喂养不能预防胃内容物误吸。
