综合医院病房中接受肠内管饲患者的配方奶输注：鼻胃管拔除和腹泻的影响

Formula delivery in patients receiving enteral tube feeding on general hospital wards: the impact of nasogastric extubation and diarrhea.

作者信息

Whelan Kevin, Hill Lydia, Preedy Victor R, Judd Patricia A, Taylor Moira A

机构信息

Nutritional Sciences Research Division, King's College London, London, UK.

出版信息

Nutrition. 2006 Oct;22(10):1025-31. doi: 10.1016/j.nut.2006.07.004. Epub 2006 Sep 15.

DOI:10.1016/j.nut.2006.07.004

PMID:16979324

Abstract

OBJECTIVE

In contrast to the intensive care unit, little is known of the percentage of formula delivered to patients receiving enteral tube feeding (ETF) on general wards or of the complications that affect its delivery. This study prospectively investigated the incidence of nasogastric extubation and diarrhea in patients starting ETF on general wards and examined their effect on formula delivery.

METHODS

In a prospective observational study, the volume of formula delivered to patients receiving ETF on general wards was compared with the volume prescribed. The incidence of nasogastric extubation and diarrhea was measured and its effect on formula delivery calculated.

RESULTS

Twenty-eight patients were monitored for a total of 319 patient days. The mean +/- SD volume of formula prescribed was 1460 +/- 213 mL/d, whereas the mean volume delivered was only 1280 +/- 418 mL/d (P < 0.001), representing a mean percentage delivery of 88 +/- 25% of prescribed formula. Nasogastric extubation occurred in 17 of 28 patients (60%), affecting 53 of the 319 patient days (17%). The percentage of formula delivered on days when the nasogastric tube remained in situ was 96 +/- 12% and on days when nasogastric extubation occurred it was only 45 +/- 31% (P < 0.001). Diarrhea affected 39 of 319 patient days (12%) but there was no difference in formula delivery on days when diarrhea did or did not occur (78% versus 89%, P = 0.295). There was a significant, albeit small, negative correlation between the daily stool score and formula delivery (correlation coefficient -0.216, P < 0.001).

CONCLUSIONS

Formula delivery is marginally suboptimal in patients receiving ETF on general wards. Nasogastric extubation is common and results in an inherent cessation of ETF until the nasogastric tube is replaced and is therefore a major factor impeding formula delivery. Diarrhea is also common but does not result in significant reductions in formula delivery.

摘要

目的

与重症监护病房不同，对于普通病房接受肠内管饲（ETF）患者的配方奶输送百分比以及影响其输送的并发症了解甚少。本研究前瞻性调查了普通病房开始接受ETF患者的鼻胃管拔除率和腹泻发生率，并研究了它们对配方奶输送的影响。

方法

在一项前瞻性观察研究中，将普通病房接受ETF患者的配方奶输送量与规定量进行比较。测量鼻胃管拔除和腹泻的发生率，并计算其对配方奶输送的影响。

结果

28例患者共监测319个患者日。规定的配方奶平均±标准差量为1460±213 mL/天，而实际输送的平均量仅为1280±418 mL/天（P<0.001），占规定配方奶的平均输送百分比为88±25%。28例患者中有17例（60%）发生鼻胃管拔除，影响了319个患者日中的53个（17%）。鼻胃管在位日的配方奶输送百分比为96±12%，鼻胃管拔除日则仅为45±31%（P<0.001）。腹泻影响了319个患者日中的39个（12%），但腹泻发生日与未发生日的配方奶输送无差异（78%对89%，P=0.295）。每日粪便评分与配方奶输送之间存在显著的负相关，尽管相关性较小（相关系数-0.216，P<0.001）。