Declercq Peter, Van der Aa Frank, De Pourcq Lutgart, Spriet Isabel
Pharmacy Department, University Hospitals Leuven, Louvain, Belgium.
Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Herestraat 49, 3000, Louvain, Belgium.
Int J Clin Pharm. 2019 Apr;41(2):408-413. doi: 10.1007/s11096-019-00800-y. Epub 2019 Mar 12.
Background After radical cystectomy, delayed return of bowel function is relatively common. Although studies investigating on the best modality for delivering nutritional support to this patient group are limited, parenteral nutrition was standard of care in those patients at the urological ward of the University Hospitals Leuven. In 2015, we published the findings from our study conducted in patients undergoing elective regular radical cystectomy at the urological ward of the University Hospitals Leuven comparing the length of hospital stay in patients with early postoperative parenteral nutrition (n = 48) versus an immediate oral nutrition protocol (n = 46). It was demonstrated that the implementation of an oral nutrition protocol was associated with a significant reduced length of hospital stay (median [IQR] of 18 [15-22] to 14 [13-18] days (p < 0.001)). The sample size was however too small to investigate the impact of the oral nutrition protocol on the incidence of catheter-related bloodstream infection, a common parenteral nutrition related complication. Objective To investigate the long term impact of an oral nutrition protocol on the incidence of catheter-related bloodstream infection, duration of catheterization and the length of hospital stay. Method Retrospectively, before (parenteral nutrition group) and after the implementation of the oral nutrition protocol (since March 10th 2010), two cohorts of 549 patients who underwent an elective regular radical cystectomy were included. The incidence of a catheter-related bloodstream infection and the length of stay were compared. A central venous catheter was present in every patient, which is standard of care. Results Catheter-related bloodstream infection was reduced from 22 (4%) to 10 (1.8%) (p = 0.031). The median duration of catheterization was 10 [7-13] days for the parenteral nutrition versus 7 [7-7] days for the oral nutrition group (p < 0.001). The median length of stay between both groups, 20 [17-25] before versus 17 [14-21] days after the implementation of the oral nutrition protocol, also differed significantly (p < 0.001). Implementing the oral nutrition protocol resulted in a parenteral nutrition associated cost saving of €470 per patient. Conclusion This large follow-up study showed that the oral nutrition protocol is associated with a reduction in catheter-related bloodstream infection. Besides, postponing parenteral nutrition in favour of oral nutrition enhances recovery.
根治性膀胱切除术后，肠道功能延迟恢复较为常见。尽管针对该患者群体提供营养支持的最佳方式的研究有限，但在鲁汶大学医院泌尿外科病房，肠外营养是这些患者的标准治疗方法。2015年，我们发表了在鲁汶大学医院泌尿外科病房对接受择期常规根治性膀胱切除术的患者进行的研究结果，比较了术后早期接受肠外营养的患者（n = 48）与立即采用口服营养方案的患者（n = 46）的住院时间。结果表明，采用口服营养方案与住院时间显著缩短相关（中位数[四分位间距]从18[15 - 22]天降至14[13 - 18]天（p < 0.001））。然而，样本量太小，无法研究口服营养方案对导管相关血流感染发生率的影响，导管相关血流感染是一种常见的肠外营养相关并发症。
研究口服营养方案对导管相关血流感染发生率、导管留置时间和住院时间的长期影响。
回顾性纳入在口服营养方案实施前（肠外营养组）和实施后（自2010年3月10日起）接受择期常规根治性膀胱切除术的两组患者，每组549例。比较导管相关血流感染发生率和住院时间。每位患者均留置中心静脉导管，这是标准治疗措施。
导管相关血流感染发生率从22例（4%）降至10例（1.8%）（p = 0.031）。肠外营养组导管留置的中位时间为10[7 - 13]天，而口服营养组为7[7 - 7]天（p < 0.001）。两组的中位住院时间也有显著差异，口服营养方案实施前为20[17 - 25]天，实施后为17[14 - 21]天（p < 0.001）。采用口服营养方案使每位患者节省了470欧元的肠外营养相关费用。
这项大型随访研究表明，口服营养方案与导管相关血流感染的减少相关。此外，推迟肠外营养而采用口服营养可促进恢复。
