Jakubczyk Marlena, Kusza Krzysztof, Różowicz Aleksandra, Rusin Justyna, Spychalska Katarzyna, Kłęk Stanisław, Szkulmowski Zbigniew, Dąbrowiecki Stanisław, Baranowski Przemysław, Paciorek Przemysław
Department of Anaesthesiology and Intensive Therapy, Collegium Medicum, Nicolaus Copernicus University in Bydgoszcz.
Anaesthesiol Intensive Ther. 2012 Aug 8;44(2):81-4.
The purpose of this retrospective study was to analyse the occurrence of gastrointestinal side effects in enterally fed ITU patients.
We analysed the records of 195 ITU patients fed enterally, over at least five days, with commercial mixtures administered as 20-h infusions. Gastric retention, the number of defecations, and incidents requiring discontinuation of enteral feeding, were noted during the first 3 days of nutrition.
Enteral nutrition was usually started during the first week of treatment (median 4, range: 1-33). In 118 patients receiving parenteral nutrition, the median day of implementing enteral feeding was day 5; some received enteral mixtures much earlier (day 2). The mean infusion rates of enteral mixtures were: 33 mL h-1 on day 1, 58 mL h-1 on day 2, and 68 mL h-1 on day 3. Gastric retention was observed in 49 (25.1%) patients during the first day, in 37 (19.0%) on day 2, and in 25 (12.8%) on day 3. Discontinuation of enteral nutrition was necessary in 6 patients due to: surgery (1), high gastric retention (4), gastrointestinal bleeding (1). A statistically significant correlation was found between the occurrence of gastric retention, infusion rates and CRP, and between the number of defecations and infusion rates.
Enteral feeding with commercial diets is well tolerated when implemented gradually. Intolerance and the need for the discontinuation of enteral feeding were usually associated with a worsening of the patient's general condition and progression of the underlying disease.
本回顾性研究的目的是分析重症监护病房（ITU）接受肠内营养患者胃肠道副作用的发生情况。
我们分析了195例在ITU接受至少5天肠内营养的患者记录，使用商业混合制剂以20小时输注的方式给药。在营养支持的前3天记录胃潴留情况、排便次数以及需要停止肠内营养的事件。
肠内营养通常在治疗的第一周开始（中位数为4天，范围：1 - 33天）。在118例接受肠外营养的患者中，开始肠内营养的中位时间为第5天；一些患者更早开始接受肠内混合制剂（第2天）。肠内混合制剂的平均输注速度为：第1天33 mL/h，第2天58 mL/h，第3天68 mL/h。第1天有49例（25.1%）患者出现胃潴留，第2天有37例（19.0%），第3天有25例（12.8%）。6例患者因以下原因需要停止肠内营养：手术（1例）、高胃潴留（4例）、胃肠道出血（1例）。胃潴留的发生、输注速度与CRP之间，以及排便次数与输注速度之间存在统计学显著相关性。
逐步实施商业饮食的肠内喂养耐受性良好。不耐受以及需要停止肠内喂养通常与患者一般状况恶化和基础疾病进展有关。
