危重症患者极早期肠内营养的可行性、安全性及结局：一项观察性研究的结果
Feasibility, safety, and outcome of very early enteral nutrition in critically ill patients: Results of an observational study.
作者信息
Shankar Bhuvaneshwari, Daphnee D K, Ramakrishnan Nagarajan, Venkataraman Ramesh
机构信息
Department of Dietetics, Apollo Hospitals, Chennai, India.
Department of Critical Care Medicine, Apollo Hospitals, Chennai, India.
出版信息
J Crit Care. 2015 Jun;30(3):473-5. doi: 10.1016/j.jcrc.2015.02.009. Epub 2015 Feb 24.
BACKGROUND
In critically ill patients, early enteral nutrition (EN) within 24 to 72 hours is recommended. Although vasopressor-dependent shock after resuscitation is not a contraindication for EN initiation, feasibility and safety of very early (within 6 hours) EN initiation soon after resuscitation are unknown.
OBJECTIVE
To evaluate the feasibility, safety, tolerance, and adequacy of very EN delivery in critically ill patients within 6 hours of intensive care unit (ICU) admission.
MATERIAL AND METHODS
Prospectively collected data from a total of 308 medical and surgical patients admitted to the ICU for at least 3 days were analyzed. The patients in whom EN was initiated within 6 hours of ICU admission (n = 166) were compared with those in whom EN was initiated after 6 hours (n = 142). Comparisons were made between groups in the percentage of target calories and proteins delivered on day 3, percentages of patients achieving target calories and proteins on day 3, incidence of feed intolerance, ICU length of stay (LOS), hospital LOS, ICU/hospital discharge, and mortality.
RESULTS
No significant differences were seen in percentage of calories (71.62% vs 71.83%; P = .09) and proteins (71.85% vs 68.89%; P = .2) delivered on day 3 between patients receiving EN within 6 hours and after 6 hours of admission. Similar number of patients achieved target calories (66.3% vs 67.6%; P = .8) and target proteins (66.9% vs 62.7%; P = .5) on day 3 in both groups. There were no significant differences between the groups for ICU LOS (11.41 days vs 11.72 days; P = .7) and hospital LOS (20.7 days vs 17.96 days; P = .1). A total of 77.1% patients were discharged in the group in whom EN was initiated within 6 hours and 67.6% patients were discharged in the group where EN was initiated after 6 hours (P = .07). The mortality rate was 22.9% and 32.4%, respectively (P = .07), in these groups. Overall incidence of EN interruption was 20.13% without significant difference between the 2 groups (<6 hours, 16.2%; >6 hours, 24.7%; P = .087).
CONCLUSION
Initiation of EN within 6 hours of ICU admission is feasible and safe and can be implemented routinely in all ICU patients.
背景
在重症患者中，建议在24至72小时内开始早期肠内营养（EN）。尽管复苏后依赖血管活性药物的休克并非开始EN的禁忌证，但复苏后很快（6小时内）开始EN的可行性和安全性尚不清楚。
目的
评估在重症监护病房（ICU）入院6小时内对重症患者进行极早期EN的可行性、安全性、耐受性和充足性。
材料与方法
对前瞻性收集的308例入住ICU至少3天的内科和外科患者的数据进行分析。将ICU入院6小时内开始EN的患者（n = 166）与6小时后开始EN的患者（n = 142）进行比较。比较两组在第3天提供的目标热量和蛋白质的百分比、第3天达到目标热量和蛋白质的患者百分比、喂养不耐受的发生率、ICU住院时间（LOS）、住院LOS、ICU/医院出院情况和死亡率。
结果
入院6小时内和6小时后接受EN的患者在第3天提供的热量百分比（71.62%对71.83%；P = 0.09）和蛋白质百分比（71.85%对68.89%；P = 0.2）方面无显著差异。两组在第3天达到目标热量（66.3%对67.6%；P = 0.8）和目标蛋白质（66.9%对62.7%；P = 0.5）的患者数量相似。两组在ICU LOS（11.41天对11.72天；P = 0.7）和住院LOS（20.7天对17.96天；P = 0.1）方面无显著差异。在入院6小时内开始EN的组中，共有77.1%的患者出院，而在6小时后开始EN的组中，这一比例为67.6%（P = 0.07）。这些组的死亡率分别为22.9%和32.4%（P = 0.07）。EN中断的总体发生率为20.13%，两组之间无显著差异（<6小时，16.2%；>6小时，24.7%；P = 0.087）。
结论
在ICU入院6小时内开始EN是可行且安全的，可在所有ICU患者中常规实施。
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