de Luis D A, Aller R, Izaola O, Terroba M C, Cabezas G, Cuellar L A
Secc. de Endocrinologia Y Nutricion Clinica Hospital U. Rio Hortega, Valladolid, Spain.
Eur J Clin Nutr. 2006 Apr;60(4):553-7. doi: 10.1038/sj.ejcn.1602354.
The wide spread use of long-term enteral nutrition and the substantive costs dictate a need to study outcome, clinical and epidemiological characteristics of these patients. The aim of our study was to analyze incidence and characteristics of a cohort of patients on HEN during 6 years, after our previous pilot study of 3 years.
Prospective observational study.
Tertiary care.
Between January 1999 and December 2004, all adult patients living in Valladolid West area who were discharged from the hospital on HEN were prospectively studied and followed up.
Information for each patient was prospectively recorded by the dietitian of the team, and include age, sex, body mass index, tricipital skinfold, midarm circumference, underlying disease, exitus, dates of initiation and discontinuation of HEN, nutrient formula, mode of administration and complications of HEN. During HEN, physicians supervised the home patients and the patients themselves or their close relative, were asked to contact our nutrition team if any problem occurred. Finally the yearly incidence of HEN was calculated each year on the basis of the estimated population in our area of recruitment, assuming almost all HEN patients were reported.
In our previous study, incidence of HEN in 1999 was patients 15 per 100,000 inhabitants, 21.3 in 2000 and decreased to 9.52 in 2001. In the new 3 years, the incidence remained in the mean levels of 1999 and 2000, the data were 17.1 per 100,000 inhabitants 26.5 in 2003 and 25.6 in 2004. The mean age of all patients was 56.4+/-17 years. The distribution of patients by diseases was; (43.8%) had a head and neck cancer, (26.8%) had human immunodeficiency virus infection, (9.6%) had a neurological disorders affecting swallowing (cerebrovacular accident and/or dementia), (4.7%) had diseases in digestive tract (fistulae, pancreatic disease, inflammatory bowel disease), (2.5%) had tumors in different locations with anorexia, (5%) had head trauma, and (7.6%) had one of several miscellaneous diseases inducing dysphagia or anorexia. HEN was administered via oral in 258 patients (70.6%) (group I), via a NGT in 95 patients (26.1%), a PEG in 9 patients (2.5%), and a jejunostomy in 3 patients (0.8%) (group II=107 patients). During the course of HEN, 12 patients had diarrhea (3.3%) and 8 (2.2%) constipation, and 4 vomiting (1.1%) that did not require cessation of HEN. No lung aspiration was detected. Hypernatremia (sodium >145 meq/l) appeared only in six cases (1.64%) and 12 cases of hyperglycaemia (3.28%). Ten patients (2.8%) reported a least one problem with the tube. The mean duration of HEN was 148.2+/-104 days. After the follow-up, 19 of the 365 patients (5.2%) had died, 346 (94.8%) were alive. In multivariant analysis, an independent factor associated with death was age (hazard ratio: 1.22; 95% CI: 1.06-1.39), adjusted by sex, route and diagnosis.
HEN has a high incidence in our area and it is a valid and safe technique for nutrition support.
长期肠内营养的广泛应用及其高昂成本表明有必要对这些患者的治疗结果、临床和流行病学特征进行研究。我们这项研究的目的是在先前3年的初步研究之后，分析一组接受家庭肠内营养（HEN）患者6年期间的发病情况及特征。
前瞻性观察性研究。
三级医疗中心。
1999年1月至2004年12月期间，居住在巴利亚多利德西区、从医院出院并接受家庭肠内营养的所有成年患者均纳入前瞻性研究并进行随访。
团队的营养师前瞻性地记录每位患者的信息，包括年龄、性别、体重指数、三头肌皮褶厚度、上臂围、基础疾病、死亡情况、家庭肠内营养开始和停止的日期、营养配方、给药方式及家庭肠内营养的并发症。在家庭肠内营养期间，医生对居家患者进行监督，要求患者本人或其近亲在出现任何问题时与我们的营养团队联系。最后，根据我们招募地区的估计人口数计算每年家庭肠内营养的发病率，假定几乎所有家庭肠内营养患者均已上报。
在我们先前的研究中，1999年家庭肠内营养的发病率为每10万居民中有15例患者，2000年为21.3例，2001年降至9.52例。在新的3年里，发病率维持在1999年和2000年的平均水平，数据分别为每10万居民中有17.1例（2002年）、26.5例（2003年）和25.6例（2004年）。所有患者的平均年龄为56.4±17岁。按疾病分类的患者分布情况为：（43.8%）患有头颈癌，（26.8%）感染人类免疫缺陷病毒，（9.6%）患有影响吞咽的神经系统疾病（脑血管意外和/或痴呆），（4.7%）患有消化道疾病（瘘管、胰腺疾病、炎症性肠病），（2.5%）患有不同部位伴有厌食的肿瘤，（5%）患有头部创伤，（7.6%）患有几种导致吞咽困难或厌食的其他杂病之一。258例患者（70.6%）通过口服方式接受家庭肠内营养（第一组），95例患者（26.1%）通过鼻胃管，9例患者（2.5%）通过经皮内镜下胃造口术，3例患者（0.8%）通过空肠造口术（第二组=107例患者）。在家庭肠内营养过程中，12例患者出现腹泻（3.3%），8例（2.2%）出现便秘，4例（1.1%）出现呕吐，这些情况均无需停止家庭肠内营养。未检测到肺部误吸。高钠血症（血钠>145 meq/l）仅出现6例（1.64%），高血糖症出现12例（3.28%）。10例患者（2.8%）报告至少出现1次与导管相关的问题。家庭肠内营养的平均持续时间为148.2±104天。随访后，365例患者中有19例（5.2%）死亡，346例（94.8%）存活。在多变量分析中，与死亡相关的独立因素是年龄（风险比：1.22；95%可信区间：1.06 - 1.39），校正了性别、途径和诊断因素。
家庭肠内营养在我们地区发病率较高，是一种有效且安全的营养支持技术。
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