标准配方与高能量配方对危重症患者胃潴留、能量输送和血糖的影响。

Effects of Standard vs Energy-Dense Formulae on Gastric Retention, Energy Delivery, and Glycemia in Critically Ill Patients.

机构信息

Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia.

出版信息

JPEN J Parenter Enteral Nutr. 2021 May;45(4):710-719. doi: 10.1002/jpen.2065. Epub 2021 Feb 18.

DOI:10.1002/jpen.2065

PMID:33543797

Abstract

BACKGROUND

Energy-dense formulae are often provided to critically ill patients with enteral feed intolerance with the aim of increasing energy delivery, yet the effect on gastric emptying is unknown. The rate of gastric emptying of a standard compared with an energy-dense formula was quantified in critically ill patients.

METHODS

Mechanically ventilated adults were randomized to receive radiolabeled intragastric infusions of 200 mL standard (1 kcal/mL) or 100 mL energy-dense (2 kcal/mL) enteral formulae on consecutive days in this noninferiority, blinded, crossover trial. The primary outcome was scintigraphic measurement of gastric retention (percentage at 120 minutes). Other measures included area under the curve (AUC) for gastric retention and intestinal energy delivery (calculated from gastric retention of formulae over time), blood glucose (peak and AUC), and intestinal glucose absorption (using 3-O-methyl-D-gluco-pyranose [3-OMG] concentrations). Comparisons were undertaken using paired mixed-effects models. Data presented are mean ± SE.

RESULTS

Eighteen patients were studied (male/female, 14:4; age, 55.2 ± 5.3 years). Gastric retention at 120 minutes was greater with the energy-dense formula (standard, 17.0 ± 5.9 vs energy-dense, 32.5 ± 7.1; difference, 12.7% [90% confidence interval, 0.8%-30.1%]). Energy delivery (AUC , 13,038 ± 1119 vs 9763 ± 1346 kcal/120 minutes; P = 0.057), glucose control (peak glucose, 10.1 ± 0.3 vs 9.7 ± 0.3 mmol/L, P = 0.362; and glucose AUC 8.7 ± 0.3 vs 8.5 ± 0.3 mmol/L.120 minutes, P = 0.661), and absorption (3-OMG AUC , 38.5 ± 4.0 vs 35.7 ± 4.0 mmol/L.120 minutes; P = .508) were not improved with the energy-dense formula.

CONCLUSION

In critical illness, administration of an energy-dense formula does not reduce gastric retention, increase energy delivery to the small intestine, or improve glucose absorption or glucose control; instead, there is a signal for delayed gastric emptying.

摘要

背景

对于存在肠内喂养不耐受的危重症患者，通常会提供能量密集型配方，以增加能量输送，但对胃排空的影响尚不清楚。本研究旨在定量比较标准配方和能量密集型配方在危重症患者中的胃排空率。

方法

在这项非劣效性、双盲、交叉试验中，连续 2 天，对机械通气的成年患者随机接受放射性标记的胃内输注 200 mL 标准（1 kcal/mL）或 100 mL 能量密集型（2 kcal/mL）肠内配方。主要结局是通过闪烁照相术测量胃潴留（120 分钟时的百分比）。其他测量指标包括胃潴留的曲线下面积（AUC）和肠道能量输送（根据配方随时间的胃潴留计算）、血糖（峰值和 AUC）和肠道葡萄糖吸收（使用 3-O-甲基-D-吡喃葡萄糖 [3-OMG] 浓度）。使用配对混合效应模型进行比较。数据以均数± SE 表示。

结果

共纳入 18 名患者（男/女，14:4；年龄，55.2±5.3 岁）。120 分钟时，能量密集型配方的胃潴留更大（标准配方为 17.0±5.9%，能量密集型配方为 32.5±7.1%；差异，12.7%[90%置信区间，0.8%-30.1%]）。能量输送（AUC，13038±1119 与 9763±1346 kcal/120 分钟；P=0.057）、血糖控制（峰值血糖，10.1±0.3 与 9.7±0.3 mmol/L，P=0.362；血糖 AUC 8.7±0.3 与 8.5±0.3 mmol/L.120 分钟，P=0.661）和吸收（3-OMG AUC，38.5±4.0 与 35.7±4.0 mmol/L.120 分钟；P=0.508）均未因能量密集型配方而改善。