Zarbock Sommer D, Steinke Doug, Hatton Jimmi, Magnuson Barbara, Smith Kelly M, Cook Aaron M
UK HealthCare, Pharmacy Services, H110, Lexington, KY, 40536, USA.
Neurocrit Care. 2008;9(2):210-6. doi: 10.1007/s12028-008-9120-9.
Adequate caloric intake is associated with improved outcome in neurocritical illness, but factors influencing the provision of enteral nutrition (EN) have not been systematically evaluated. The primary goal of the study was to determine the EN intake of neurosurgical intensive care unit (ICU) patients within the first week of illness and investigate the factors contributing to achieving caloric goals.
A retrospective cohort of adult patients admitted to the neurosurgery service (NS) during August 2005-August 2006 were randomly selected and stratified into three groups based on their ICU-admission Glasgow Coma Scale Score (GCS) (GCS > 11, GCS 8-11, GCS 4-7). Daily EN intake, GCS, and other clinical data were collected.
A total of 71 patients were included (GCS > 11 = 23, GCS 8-11 = 23, GCS 4-7 = 25). Admitting diagnoses included traumatic brain injury (TBI) (32%), subarachnoid hemorrhage (SAH) (32%), and intracerebral hemorrhage (17%). The overall in-hospital mortality was 23.9%. Overall, the maximum daily mean calories provided was 1,100 kcal (mean of 55% of caloric goal on hospital day 6). The median time to feeding was approximately 3 days in each group. GCS did not appear to significantly affect the mean % of caloric goal administered in patients with a minimum daily GCS < or = 11 (P = 0.053). Multivariate analysis revealed that clinical care factors, such as time to EN orders and enteral access confirmation, were significant impediments to EN provision (P = 0.001).
System-based clinical care factors appear to have great impact on the successful provision of EN in the first week of neurocritical illness.
充足的热量摄入与神经危重症患者预后改善相关，但影响肠内营养（EN）供应的因素尚未得到系统评估。本研究的主要目标是确定神经外科重症监护病房（ICU）患者发病第一周内的肠内营养摄入量，并调查有助于实现热量目标的因素。
随机选取2005年8月至2006年8月期间入住神经外科（NS）的成年患者回顾性队列，并根据其入住ICU时的格拉斯哥昏迷量表评分（GCS）分为三组（GCS>11、GCS 8 - 11、GCS 4 - 7）。收集每日肠内营养摄入量、GCS及其他临床数据。
共纳入71例患者（GCS>11 = 23例，GCS 8 - 11 = 23例，GCS 4 - 7 = 25例）。入院诊断包括创伤性脑损伤（TBI）（32%）、蛛网膜下腔出血（SAH）（32%）和脑出血（17%）。总体院内死亡率为23.9%。总体而言，每日提供的最大平均热量为1100千卡（住院第6天平均为热量目标的55%）。每组开始喂养的中位时间约为3天。在每日最低GCS≤11的患者中，GCS似乎并未显著影响给予的热量目标平均百分比（P = 0.053）。多因素分析显示，临床护理因素，如下达肠内营养医嘱的时间和肠内通路确认，是肠内营养供应的显著障碍（P = 0.001）。
基于系统的临床护理因素似乎对神经危重症发病第一周内成功提供肠内营养有很大影响。
