Mullan H, Roubenoff R A, Roubenoff R
Department of Nutrition, Johns Hopkins Hospital, Baltimore, Maryland.
JPEN J Parenter Enteral Nutr. 1992 Mar-Apr;16(2):160-4. doi: 10.1177/0148607192016002160.
We investigated the prevalence, incidence, and risk factors for pulmonary aspiration in all tube-fed adult patients over 6 months. Twelve aspiration events occurred among 276 patients (prevalence, 4.4%; 95% confidence interval, 2.2% to 7.6%). The incidence of aspiration was 2.4 per 1000 tube-feeding days (95% confidence interval, 1.2 to 3.9 per 1000). Despite 17% overall mortality, there was no excess mortality and little morbidity associated with aspiration. The major risk factors for aspiration were patient age (p less than .015) and location in the hospital (p less than .008): the probability of aspiration in the intensive care units (n = 113) was 0.9% compared with 4.9% on medical or surgical wards (n = 142), 16.7% among patients transferred from the intensive care unit to the ward (n = 18), and 33% among patients transferred from the ward to the intensive care unit (n = 3). Pulmonary aspiration is an uncommon and generally benign event among enterally supported patients. More frequent aspiration among ward than intensive care unit patients suggests that aspiration is not an inevitable consequence of severe illness, but can be prevented with adequate nursing care and pulmonary precautions. The fear of aspiration is not a sufficient cause to withhold enteral nutrition support in acutely ill patients.
我们调查了所有接受管饲6个月以上成年患者的肺误吸患病率、发病率及危险因素。276例患者中发生了12次误吸事件（患病率为4.4%；95%置信区间为2.2%至7.6%）。误吸发病率为每1000个管饲日2.4次（95%置信区间为每1000个管饲日1.2至3.9次）。尽管总体死亡率为17%，但误吸相关的额外死亡率不高，且几乎没有发病情况。误吸的主要危险因素为患者年龄（p<0.015）及医院内所在位置（p<0.008）：重症监护病房（n=113）患者的误吸概率为0.9%，而内科或外科病房（n=142）患者为4.9%，从重症监护病房转至病房的患者（n=18）中为16.7%，从病房转至重症监护病房的患者（n=3）中为33%。在接受肠内营养支持的患者中，肺误吸是一种不常见且通常为良性的事件。病房患者比重症监护病房患者误吸更频繁，这表明误吸并非重症疾病的必然结果，但通过充分的护理及肺部预防措施是可以预防的。对于急性病患者，担心误吸并不是拒绝给予肠内营养支持的充分理由。
