老年机械通气患者（年龄≥75 岁）经胃与幽门后肠内营养：一项单中心随机试验。
Gastric versus postpyloric enteral nutrition in elderly patients (age ≥ 75 years) on mechanical ventilation: a single-center randomized trial.
机构信息
Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, 510220, China.
Institute of Clinical Nutrition, Guangzhou Red Cross Hospital, Medical College, Jinan University, Tongfuzhong Road No. 396, Guangzhou, 510220, China.
出版信息
Crit Care. 2018 Jul 5;22(1):170. doi: 10.1186/s13054-018-2092-z.
BACKGROUND
The risk of ventilator-associated pneumonia (VAP) is reduced when postpyloric enteral nutrition (EN) is administered compared to when gastric EN is administered in specific populations. In the present study, we tested the hypothesis that postpyloric EN is superior to gastric EN in reducing the incidence of VAP in elderly patients (age ≥ 75 years) who are admitted to the intensive care unit (ICU) and require mechanical ventilation.
METHODS
We performed a single-center randomized clinical trial involving elderly patients (age ≥ 75 years) who were admitted to the ICU and required mechanical ventilation. The patients were randomly assigned to either the postpyloric EN group or the gastric EN group. The primary outcome was the VAP rate.
RESULTS
Of the 836 patients screened, 141 patients were included in the study (70 in the postpyloric EN group and 71 in the gastric EN group). The patients in the postpyloric EN group were 82.0 (75.0-99.0) years old (male 61.4%), and those in the gastric EN group were 82.0 (75.0-92.0) years old (male 63.4%). The Acute Physiology and Chronic Health Evaluation II scores were 28.09 ± 6.75 in the postpyloric EN group and 27.80 ± 7.60 in the gastric EN group (P = 0.43). VAP was observed in 8 of 70 patients (11.4%) in the postpyloric EN group and in 18 of 71 patients (25.4%) in the gastric EN group, which resulted in a significant between-group difference (OR 0.38, 95% CI 0.15-0.94; P = 0.04). In the postpyloric EN group, there were significant reductions in vomiting (12 patients in the postpyloric EN group vs 29 patients in the gastric EN group; OR 0.30, 95% CI 0.14-0.65; P = 0.002) and abdominal distension (18 patients in the postpyloric EN group vs 33 patients in the gastric EN group; OR 0.40, 95% CI 0.20-0.81; P = 0.01). No significant differences were observed between the two groups regarding mortality and other secondary outcomes.
CONCLUSIONS
Our study demonstrated that, compared with gastric EN, postpyloric EN reduced the VAP rate among elderly patients who were admitted to the ICU and required mechanical ventilation.
TRIAL REGISTRATION
Chinese Clinical Trial Registry, ChiCTR-IPR-16008485 . Registered on 17 May 2016.
背景
与胃内营养相比，在特定人群中，幽门后肠内营养（EN）可降低呼吸机相关性肺炎（VAP）的风险。在本研究中，我们检验了这样一个假设，即在需要机械通气的老年患者（年龄≥75 岁）中，幽门后 EN 可降低 VAP 的发生率，优于胃内 EN。
方法
我们进行了一项单中心随机临床试验，纳入了入住重症监护病房（ICU）并需要机械通气的老年患者（年龄≥75 岁）。患者被随机分配到幽门后 EN 组或胃内 EN 组。主要结局是 VAP 发生率。
结果
在筛选的 836 名患者中，141 名患者纳入了研究（幽门后 EN 组 70 例，胃内 EN 组 71 例）。幽门后 EN 组患者年龄为 82.0（75.0-99.0）岁（男性 61.4%），胃内 EN 组患者年龄为 82.0（75.0-92.0）岁（男性 63.4%）。急性生理学和慢性健康评估 II 评分在幽门后 EN 组为 28.09±6.75，在胃内 EN 组为 27.80±7.60（P=0.43）。幽门后 EN 组 70 例患者中有 8 例（11.4%）发生 VAP，胃内 EN 组 71 例患者中有 18 例（25.4%）发生 VAP，两组间差异有统计学意义（OR 0.38，95%CI 0.15-0.94；P=0.04）。在幽门后 EN 组中，呕吐（幽门后 EN 组 12 例 vs 胃内 EN 组 29 例；OR 0.30，95%CI 0.14-0.65；P=0.002）和腹胀（幽门后 EN 组 18 例 vs 胃内 EN 组 33 例；OR 0.40，95%CI 0.20-0.81；P=0.01）的发生率显著降低。两组间死亡率和其他次要结局无显著差异。
结论
与胃内 EN 相比，幽门后 EN 可降低入住 ICU 并需要机械通气的老年患者的 VAP 发生率。
试验注册
中国临床试验注册中心，ChiCTR-IPR-16008485。于 2016 年 5 月 17 日注册。
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