肠内营养喂养在中国重症监护病房：一项涉及 116 家医院的横断面研究。
Enteral nutrition feeding in Chinese intensive care units: a cross-sectional study involving 116 hospitals.
机构信息
Nanjing General Hospital of Nanjing Military Command, No.305 Zhongshan East Road, Nanjing, 210002, China.
Department of emergency medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
出版信息
Crit Care. 2018 Sep 24;22(1):229. doi: 10.1186/s13054-018-2159-x.
BACKGROUND
There is a lack of large-scale epidemiological data on the clinical practice of enteral nutrition (EN) feeding in China. This study aimed to provide such data on Chinese hospitals and to investigate factors associated with EN delivery.
METHODS
This cross-sectional study was launched in 118 intensive care units (ICUs) of 116 mainland hospitals and conducted on April 26, 2017. At 00:00 on April 26, all patients in these ICUs were included. Demographic and clinical variables of patients on April 25 were obtained. The dates of hospitalization, ICU admission and nutrition initiation were reviewed. The outcome status 28 days after the day of investigation was obtained.
RESULTS
A total of 1953 patients were included for analysis, including 1483 survivors and 312 nonsurvivors. The median study day was day 7 (IQR 2-19 days) after ICU entry. The proportions of subjects starting EN within 24, 48 and 72 h after ICU entry was 24.8% (84/352), 32.7% (150/459) and 40.0% (200/541), respectively. The proportion of subjects receiving > 80% estimated energy target within 24, 48, 72 h and 7 days after ICU entry was 10.5% (37/352), 10.9% (50/459), 11.8% (64/541) and 17.8% (162/910), respectively. Using acute gastrointestinal injury (AGI) 1 as the reference in a Cox model, patients with AGI 2-3 were associated with reduced likelihood of EN initiation (HR 0.46, 95% CI 0.353-0.599; p < 0.001). AGI 4 was significantly associated with lower hazard of EN administration (HR 0.056; 95% CI 0.008-0.398; p = 0.004). In a linear regression model, greater Sequential Organ Failure Assessment scores (coefficient - 0.002, 95% CI - 0.008 to - 0.001; p = 0.024) and male gender (coefficient - 0.144, 95% CI - 0.203 to - 0.085; p < 0.001) were found to be associated with lower EN proportion. As compared with AGI 1, AGI 2-3 was associated with lower EN proportion (coefficient - 0.206, 95% CI - 0.273 to - 0.139; p < 0.001).
CONCLUSIONS
The study showed that EN delivery was suboptimal in Chinese ICUs. More attention should be paid to EN use in the early days after ICU admission.
背景
中国缺乏大规模的肠内营养（EN）临床实践的流行病学数据。本研究旨在提供中国医院的此类数据，并调查与 EN 输送相关的因素。
方法
这是一项横断面研究，于 2017 年 4 月 26 日在 116 家大陆医院的 118 个重症监护病房（ICU）开展。在 4 月 26 日 00:00，纳入这些 ICU 中的所有患者。获取患者 4 月 25 日的人口统计学和临床变量。回顾住院日期、ICU 入院和营养启动日期。获得调查日后 28 天的结局状态。
结果
共纳入 1953 名患者进行分析，包括 1483 名幸存者和 312 名非幸存者。研究日中位数为 ICU 进入后第 7 天（IQR 2-19 天）。ICU 进入后 24、48 和 72 小时内开始 EN 的患者比例分别为 24.8%（84/352）、32.7%（150/459）和 40.0%（200/541）。ICU 进入后 24、48、72 小时和 7 天内接受>80%估计能量目标的患者比例分别为 10.5%（37/352）、10.9%（50/459）、11.8%（64/541）和 17.8%（162/910）。在 Cox 模型中，将急性胃肠损伤（AGI）1 作为参考，AGI 2-3 的患者 EN 起始的可能性降低（HR 0.46，95%CI 0.353-0.599；p<0.001）。AGI 4 与较低的 EN 管理风险显著相关（HR 0.056；95%CI 0.008-0.398；p=0.004）。在线性回归模型中，较高的序贯器官衰竭评估评分（系数-0.002，95%CI-0.008 至-0.001；p=0.024）和男性（系数-0.144，95%CI-0.203 至-0.085；p<0.001）与较低的 EN 比例相关。与 AGI 1 相比，AGI 2-3 与较低的 EN 比例相关（系数-0.206，95%CI-0.273 至-0.139；p<0.001）。
结论
本研究表明，中国 ICU 中的 EN 输送并不理想。应更加关注 ICU 入院后早期的 EN 使用。
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