Kingston Hospital NHS Trust, Kingston upon Thames, Surrey, UK.
Clin Med (Lond). 2013 Jun;13(3):248-51. doi: 10.7861/clinmedicine.13-3-248.
This paper describes three elderly patients who were admitted to hospital with aspiration pneumonia. They were kept nil by mouth (NBM) for a number of days, while being given intravenous hydration initially and enteral feeding subsequently. During that time they deteriorated and appeared to be dying, so the Liverpool Care Pathway (LCP) for the dying was used to support their care. Artificial nutrition and hydration were stopped. They quickly improved and the LCP was discontinued. Two of the patients deteriorated again on reintroduction of enteral feeding and/or intravenous fluids, only to improve a second time following withdrawal of feeding and fluids. Vulnerable elderly patients should not be made NBM except as a last resort. Clinicians should be alert to the possibility of refeeding syndrome and overhydration as reversible causes of clinical deterioration, particularly in frail elderly patients. Use of the LCP in these patients provided a unique opportunity to witness the positive effects of withdrawal of excessive artificial nutrition and hydration.
本文描述了三位因吸入性肺炎住院的老年患者。他们在接受静脉补液治疗的同时，被禁食数日。在此期间，他们的病情恶化，似乎濒临死亡，因此使用临终关怀路径（Liverpool Care Pathway，LCP）来支持他们的治疗。停止了人工营养和水合作用。他们迅速好转，随后停止了 LCP 治疗。其中两名患者在重新开始肠内喂养和/或静脉输液后再次恶化，只有在停止喂养和输液后才再次好转。除非作为最后的手段，否则不应让脆弱的老年患者禁食。临床医生应该警惕喂养综合征和水合过度作为临床恶化的可逆原因的可能性，尤其是在体弱的老年患者中。在这些患者中使用 LCP 提供了一个独特的机会，可以观察到停止过度人工营养和水合作用的积极效果。
