Department of Nutrition Services, Alberta Health Services, Calgary, Alberta, Canada.
JPEN J Parenter Enteral Nutr. 2013 Mar;37(2):261-7. doi: 10.1177/0148607112464654. Epub 2012 Oct 24.
Enteral nutrition within 48 hours of intensive care unit (ICU) admission is recommended for the ICU population. Major vascular surgery patients have a higher incidence of pre- and postoperative malnutrition compared with the general surgical population. Our objectives were to determine if early feeding (within 48 hours of admission) is achievable and well tolerated, identify factors that predict early feeding, and determine if there is an association between early feeding and in-hospital mortality among abdominal aortic aneurysm (AAA) repair patients.
A retrospective cohort study was conducted among 145 postsurgical AAA repair patients admitted to the ICU within 48 hours of surgery. Kaplan-Meier methods and Cox proportional hazard multiple regression were used to analyze the data.
Only 35 (24%) patients received early feeding. Patients were more likely to be fed early if they were male (adjusted hazard ratio [aHR] = 2.3; 95% confidence interval [CI], 0.8-6.7; P = .13), had endovascular AAA repair (aHR = 2.9; 95% CI, 1.4-6.2; P = .006), had less blood loss (<4 L) during surgery (aHR = 2.3; 95% CI, 0.7-7.2; P = .14), and had shorter length of ventilation (<48 hours) (aHR = 2.2; 95% CI, 1.1-4.8; P = .048). Of 44 patients fed via enteral nutrition (EN), 27 (61%) achieved nutrition adequacy (>80% EN goal) during ICU admission. After controlling for other factors, 14-day mortality was not related to feeding time (aHR = 1.1; P = .88).
Early feeding was achieved in a minority of patients following AAA repair, was related to type of surgery and duration of mechanical ventilation, and was tolerated as well as later introduced feedings. Randomized trials are needed to determine safety and benefits of early feeding in this patient group.
建议重症监护病房（ICU）入住 48 小时内开始肠内营养。与普通外科人群相比，大血管外科患者术前和术后营养不良的发生率更高。我们的目标是确定早期喂养（入院后 48 小时内）是否可行且耐受良好，确定预测早期喂养的因素，以及确定腹主动脉瘤（AAA）修复患者中早期喂养与院内死亡率之间是否存在关联。
对 145 例术后 48 小时内入住 ICU 的 AAA 修复患者进行回顾性队列研究。使用 Kaplan-Meier 方法和 Cox 比例风险多变量回归分析数据。
只有 35 名（24%）患者接受了早期喂养。如果患者为男性（调整后的危险比[aHR]=2.3；95%置信区间[CI]，0.8-6.7；P=.13）、接受血管内 AAA 修复（aHR=2.9；95% CI，1.4-6.2；P=.006）、手术期间失血量较少（<4 L）（aHR=2.3；95% CI，0.7-7.2；P=.14）和通气时间较短（<48 小时）（aHR=2.2；95% CI，1.1-4.8；P=.048），则更有可能早期喂养。在 44 名接受肠内营养（EN）喂养的患者中，有 27 名（61%）在 ICU 住院期间达到营养充足（>80%EN 目标）。在控制其他因素后，14 天死亡率与喂养时间无关（aHR=1.1；P=.88）。
AAA 修复后只有少数患者能够早期喂养，与手术类型和机械通气时间有关，且耐受情况与后期引入的喂养相同。需要进行随机试验来确定该患者群体中早期喂养的安全性和益处。
