Department of Life Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, No. 1 University Rd., Tainan City 701, Taiwan.
J Acad Nutr Diet. 2012 Aug;112(8):1138-46. doi: 10.1016/j.jand.2012.04.013. Epub 2012 Jun 7.
Few trials have studied the influence of illness severity on clinical outcomes of different tube-feeding routes. Whether gastric or postpyloric feeding route is more beneficial to patients receiving enteral nutrition remains controversial.
To test whether illness severity influences the efficacy of enteral feeding route on clinical outcomes in patients with critical illness.
A 2-year prospective, randomized, clinical study was conducted to assess the differences between the nasogastric (NG) and nasoduodenal (ND) tube feedings on clinical outcomes.
PARTICIPANTS/SETTING: One hundred one medical adult intensive care unit (ICU) patients requiring enteral nutrition were enrolled in this study.
Patients were randomly assigned to the NG (n=51) or ND (n=50) feeding route during a 21-day study period. Illness severity was dichotomized as "less severe" and "more severe," with the cutoff set at Acute Physiology and Chronic Health Evaluation II score of 20.
Daily energy and protein intake, feeding complications (eg, gastric retention/vomiting/diarrhea/gastrointestinal bleeding), length of ICU stay, hospital mortality, nitrogen balance, albumin, and prealbumin.
Two-tailed Student t tests and Mann-Whitney U tests were used to analyze significant differences between variables in the study groups. Multiple regression was used to assess the effects of illness severity and enteral feeding routes on clinical outcomes.
Among less severely ill patients, no differences existed between the NG and ND groups in daily energy and protein intake, feeding complications, length of ICU stay, and nitrogen balance. Among more severely ill patients, the NG group experienced lower energy and protein intake, more tube feeding complications, longer ICU stay, and poorer nitrogen balance than the ND group.
To optimize nutritional support and taking medical resources into account, the gastric feeding route is recommended for less severely ill patients and the postpyloric feeding route for more severely ill patients.
很少有试验研究疾病严重程度对不同管饲途径临床结局的影响。胃饲或幽门后喂养途径对接受肠内营养的患者更有益，这一点仍存在争议。
检验疾病严重程度是否影响危重患者肠内喂养途径的疗效。
进行了一项为期 2 年的前瞻性、随机、临床研究，以评估鼻胃（NG）和鼻肠（ND）管饲在临床结局方面的差异。
参与者/设置：本研究纳入了 101 例需要肠内营养的成年重症监护病房（ICU）患者。
患者在 21 天的研究期间随机分配至 NG（n=51）或 ND（n=50）喂养途径。疾病严重程度分为“较轻”和“较重”，截断值为急性生理学和慢性健康评估 II 评分 20。
每日能量和蛋白质摄入量、喂养并发症（如胃潴留/呕吐/腹泻/胃肠道出血）、ICU 住院时间、住院死亡率、氮平衡、白蛋白和前白蛋白。
使用双侧 Student t 检验和 Mann-Whitney U 检验分析研究组变量之间的显著差异。使用多元回归评估疾病严重程度和肠内喂养途径对临床结局的影响。
在疾病较轻的患者中，NG 组和 ND 组在每日能量和蛋白质摄入量、喂养并发症、ICU 住院时间和氮平衡方面无差异。在疾病较重的患者中，与 ND 组相比，NG 组的能量和蛋白质摄入较低，喂养并发症较多，ICU 住院时间较长，氮平衡较差。
为了优化营养支持并考虑医疗资源，建议对疾病较轻的患者采用胃饲途径，对疾病较重的患者采用幽门后喂养途径。
