Department of Otolaryngology, University of California Davis Medical Center, Sacramento, California, USA.
Department of Internal Medicine, University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas, USA.
JPEN J Parenter Enteral Nutr. 2019 Aug;43(6):742-749. doi: 10.1002/jpen.1469. Epub 2018 Dec 3.
Although feeding intolerance is a common complication in trauma patients, the incidence, development, and effects are poorly understood.
We performed a retrospective study in which trauma patients were classified as having feeding intolerance based on time to reach feeding goal. Subsequently, we sorted patients by gastric residual volumes (GRVs) or symptoms of slowed gastrointestinal motility.
One-third of trauma patients experienced delayed time to reach feeding goal after diet initiation. Delayed feeding was associated with prolonged intensive care unit (ICU) stays, increased readmission rates, and increased incidence of sepsis. Patients with elevated GRV (>500 mL) had significantly prolonged ICU and hospital stays and increase incidence of sepsis. Patients with >2 symptoms of slowed gastrointestinal motility had prolonged ICU and hospital stays, delayed time to reach feeding goals, significantly increased readmission rates, increased incidence of infectious and thromboembolic complications and sepsis, decreased serum prealbumin levels, and increased CRP levels.
Decreased gastrointestinal motility in trauma patients is associated with worse outcomes and increased systemic inflammation.
尽管喂养不耐受是创伤患者的常见并发症，但对其发病率、发展和影响知之甚少。
我们进行了一项回顾性研究，根据达到喂养目标的时间将创伤患者分为喂养不耐受。随后，我们根据胃残留量（GRV）或胃肠道蠕动减慢的症状对患者进行分类。
三分之一的创伤患者在开始饮食后出现达到喂养目标的时间延迟。喂养延迟与重症监护病房（ICU）停留时间延长、再入院率增加和脓毒症发生率增加有关。GRV 升高（>500 mL）的患者 ICU 和住院时间明显延长，且脓毒症发生率增加。>2 个胃肠道蠕动减慢症状的患者 ICU 和住院时间延长，达到喂养目标的时间延迟，再入院率显著增加，感染和血栓栓塞并发症及脓毒症发生率增加，血清前白蛋白水平降低，CRP 水平升高。
创伤患者的胃肠道动力下降与预后较差和全身炎症增加有关。
