Cuerda C, Planas M, Gómez Candela C, Luengo L M
Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Nutr Hosp. 2009 May-Jun;24(3):347-53.
There are few data on trends in home enteral nutrition (HEN) practice in different countries. NADYA is the Spanish home artificial nutrition (HAN) group, and is responsible for the Spanish HAN registry.
We performed a 16-year retrospective study (1992-2007) of the Spanish HEN registry by retrieving data from the NADYA database and from publications of the working group. People receiving more than 1000 kcal/d with an enteral formula were included regardless of the access route (oral/tube feeding).
The number of patients registered increased more than 8 times during the study period: the current prevalence is 113 patients/10(6) inhabitants (oral and tube feeding), or 41 patients/10(6) inhabitants (tube feeding). The distribution of the patients was not uniform, and most came from six autonomous communities (Catalonia, Galicia, Castilla-León, Madrid, Andalusia and Extremadura). Gender distribution was nearly 1:1. The number of paediatric patients was very low, representing less than 10% of the total. Mean age in adults was above 65 years in most of the reports. We observed an increase in the age of the patients over the years. The most common underlying diseases were neurological disorders, followed by cancer. We observed an increase in the use of the oral route, from 5.8% in 1992 to 64% in 2007, with a parallel decrease in the use of nasogastric tubes. Gastrostomy tubes were used in 15-20% of the patients. The number of complications was low (less than one complication/patient/year), the most frequent being change of tube, followed by gastrointestinal complications. The principal reasons for discontinuing treatment were death related to the underlying disease (40-50%) and switch to oral diet (30-40%). Most of the patients (75%) were followed by the hospital nutrition unit. Provision of the enteral formula and disposables varied according to the autonomous community. Most of the patients had limited physical activity or were chair- or bed-bound, requiring partial or total help in their daily life.
The use of HEN has increased dramatically in the last 16 years in Spain. Most of the patients registered were elderly people with neurological disorders and limited physical activity. The oral route was the most frequently used. The number of complications was low. The mortality rate in these patients was highly related to the underlying disease.
关于不同国家家庭肠内营养（HEN）实践趋势的数据较少。NADYA是西班牙家庭人工营养（HAN）组织，负责西班牙HAN登记处的工作。
我们通过从NADYA数据库和工作组出版物中检索数据，对西班牙HEN登记处进行了一项为期16年的回顾性研究（1992 - 2007年）。纳入接受肠内配方奶且每日热量摄入超过1000千卡的人群，无论其营养摄入途径（口服/管饲）。
在研究期间，登记的患者数量增加了8倍多：目前的患病率为113例/10⁶居民（口服和管饲），或41例/10⁶居民（管饲）。患者分布不均衡，大多数来自六个自治区（加泰罗尼亚、加利西亚、卡斯蒂利亚 - 莱昂、马德里、安达卢西亚和埃斯特雷马杜拉）。性别分布接近1:1。儿科患者数量非常少，占总数不到10%。在大多数报告中，成年人的平均年龄在65岁以上。我们观察到这些年患者年龄有所增加。最常见的基础疾病是神经系统疾病，其次是癌症。我们观察到口服途径的使用有所增加，从1992年的5.8%增至2007年的64%，同时鼻胃管的使用相应减少。15% - 20%的患者使用胃造口管。并发症数量较少（每年每位患者少于1例并发症），最常见的是更换管道，其次是胃肠道并发症。停止治疗的主要原因是与基础疾病相关的死亡（40% - 50%）和改为口服饮食（30% - 40%）。大多数患者（75%）由医院营养科随访。肠内配方奶和一次性用品的供应因自治区而异。大多数患者身体活动受限或需坐轮椅或卧床，日常生活需要部分或全部帮助。
在过去16年中，西班牙家庭肠内营养的使用显著增加。登记的大多数患者是患有神经系统疾病且身体活动受限的老年人。口服途径是最常用的。并发症数量较少。这些患者的死亡率与基础疾病高度相关。
