Gao Jian, Tu Guo-Wei, Wang Chun-Sheng, Zhu Du-Ming, Liu Lan, Liu Hua, Yang Xiao-Mei, Luo Zhe
Department of Nutrition, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
J Thorac Dis. 2018 Feb;10(2):920-929. doi: 10.21037/jtd.2018.01.98.
To evaluate the effect of restriction of soybean-based intravenous fat emulsions (IVFEs) in clinical outcomes in cardiac surgical patients.
This was a before-and-after interventional study comparing the clinical outcomes regarding the intervention of IVFEs restriction. Before August 2015, parenteral nutrition (PN) using a soy-based lipid emulsion was routinely implemented if patients failed to meet >60% of energy requirements in 48 h post cardiac surgery (Period A). Beginning in August 2015, a lipid restriction strategy was implemented in our cardiac surgery intensive care unit (CSICU) unless enteral route could not be established within 7 days (Period B). The ICU and hospital mortality, nosocomial infections during ICU stay, length of ICU and hospital stay, ICU and hospital cost, mechanical ventilation time and postoperative complications were compared between two periods.
A total of 761 patients (370 patients in Period A and 391 patients in Period B) were ultimately enrolled in this study. There were no significant differences in demographic characteristics and intraoperative and postoperative parameters between the two groups. After the implementation of IVFEs restriction, the overall ICU mortality and hospital mortality were similar between two groups. Nosocomial infection rate was significantly reduced (3.84% 7.84%, P=0.021). The mean length of ICU stay (3.15 3.74 days, P<0.001) and hospital stay (12.14 13.24 days, P<0.001) were significantly lower. The mean in-hospital cost (133,368 139,383 Yuan, P=0.037) was found to be reduced after implementation of IVFEs restriction. The duration of mechanical ventilation was shorter in the latter period (35.23±10.43 47.63±12.54 hours, P=0.011). IVFEs restriction was also associated with reduced cholestasis (2.81% 6.76%, P=0.013).
The implementation of soybean-based IVFEs restriction in cardiac surgical patients was associated with reduced postoperative nosocomial infection rate. It also led to reductions in the length of ICU/hospital stay, hospital costs and mechanical ventilation time and a lower incidence of cholestasis. Further studies are required to validate the conclusions.
评估限制使用大豆基静脉脂肪乳剂（IVFE）对心脏外科手术患者临床结局的影响。
这是一项前后对照的干预性研究，比较限制IVFE干预措施后的临床结局。2015年8月之前，如果心脏手术后48小时内患者能量需求未满足>60%，则常规采用基于大豆脂质乳剂的肠外营养（PN）（A期）。从2015年8月开始，除非在7天内无法建立肠内营养途径，否则在我们的心脏外科重症监护病房（CSICU）实施脂质限制策略（B期）。比较两个时期的ICU和医院死亡率、ICU住院期间的医院感染、ICU和医院住院时间、ICU和医院费用、机械通气时间及术后并发症。
本研究最终纳入761例患者（A期370例，B期391例）。两组患者的人口统计学特征以及术中和术后参数无显著差异。实施IVFE限制后，两组的总体ICU死亡率和医院死亡率相似。医院感染率显著降低（3.84%对7.84%，P=0.021）。ICU平均住院时间（3.15对3.74天，P<0.001）和医院住院时间（12.14对13.24天，P<0.001）显著缩短。实施IVFE限制后，发现平均住院费用降低（133,368对139,383元，P=0.037）。后期机械通气时间较短（35.23±10.43对47.63±12.5小时，P=0.011）。IVFE限制还与胆汁淤积减少相关（2.81%对6.76%，P=0.013）。
对心脏外科手术患者实施大豆基IVFE限制与术后医院感染率降低相关。它还导致ICU/医院住院时间缩短、医院费用降低、机械通气时间缩短以及胆汁淤积发生率降低。需要进一步研究以验证这些结论。
