危重症患者早期使用补充性肠外营养：一项国际多中心观察性研究的结果。

Early use of supplemental parenteral nutrition in critically ill patients: results of an international multicenter observational study.

机构信息

Capital Health Authority, Edmonton, AB, Canada.

出版信息

Crit Care Med. 2011 Dec;39(12):2691-9. doi: 10.1097/CCM.0b013e3182282a83.

DOI:10.1097/CCM.0b013e3182282a83

PMID:21765355

Abstract

OBJECTIVE

To evaluate the effect of using supplemental parenteral nutrition compared to early enteral nutrition alone on nutritional and clinical outcomes.

DESIGN

A multicenter, observational study.

SETTING

Two hundred twenty-six intensive care units from 29 Countries.

PATIENTS

Mechanically ventilated critically ill adult patients that remained in the intensive care unit for >72 hrs and received early enteral nutrition within 48 hrs from admission.

INTERVENTIONS

Data were collected on patient characteristics and daily nutrition practices for up to 12 days. Patient outcomes were recorded after 60 days.

MEASUREMENTS AND MAIN RESULTS

We compared the outcomes of patients who received early enteral nutrition alone, early enteral nutrition + early parenteral nutrition, and early enteral nutrition + late parenteral nutrition (after 48 hrs of admission). Cox regression analyses were conducted to determine the effect of feeding strategy, adjusted for other confounding variables, on time to being discharged alive from hospital. A total of 2,920 patients were included in this study; 2562 (87.7%) in the early enteral nutrition group, 188 (6.4%) in the early parenteral nutrition group, and 170 (5.8%) in the late parenteral nutrition group. Adequacy of calories and protein was highest in the early parenteral nutrition group (81.2% and 80.1%, respectively) and lowest in the early enteral nutrition group (63.4% and 59.3%) (p < .0001). The 60-day mortality rate was 27.8% in the early enteral nutrition group, 34.6% in the early parenteral nutrition group, and 35.3% in the late parenteral nutrition group (p = .02). The rate of patients discharged alive from hospital was slower in the group that received early parenteral nutrition (unadjusted hazard ratio 0.75, 95% confidence interval 0.59-0.96) and late parenteral nutrition (hazard ratio 0.64, 95% confidence interval 0.51-0.81) (p = .0003) compared to early enteral nutrition. These findings persisted after adjusting for known confounders.

CONCLUSIONS

The supplemental use of parenteral nutrition may improve provision of calories and protein but is not associated with any clinical benefit.

摘要

目的

评估与单纯早期肠内营养相比，补充肠外营养对营养和临床结局的影响。

设计

多中心观察性研究。

设置

来自 29 个国家的 226 个重症监护病房。

患者

入住重症监护病房>72 小时且入院后 48 小时内接受早期肠内营养的机械通气危重症成年患者。

干预

在 12 天内收集患者特征和每日营养实践的数据。在 60 天后记录患者结局。

测量和主要结果

我们比较了接受单纯早期肠内营养、早期肠内营养+早期肠外营养以及早期肠内营养+晚期肠外营养（入院后 48 小时）的患者结局。Cox 回归分析用于确定喂养策略的效果，调整其他混杂变量，对从医院出院存活的时间进行调整。共纳入 2920 例患者；早期肠内营养组 2562 例（87.7%），早期肠外营养组 188 例（6.4%），晚期肠外营养组 170 例（5.8%）。热量和蛋白质的充足程度在早期肠外营养组最高（分别为 81.2%和 80.1%），在早期肠内营养组最低（分别为 63.4%和 59.3%）（p<0.0001）。早期肠内营养组 60 天死亡率为 27.8%，早期肠外营养组为 34.6%，晚期肠外营养组为 35.3%（p=0.02）。与早期肠内营养相比，接受早期肠外营养（校正危害比 0.75，95%置信区间 0.59-0.96）和晚期肠外营养（危害比 0.64，95%置信区间 0.51-0.81）的患者出院率较慢（p=0.0003）。这些发现在调整已知混杂因素后仍然存在。