Peng Jianhua, Volbers Bastian, Sprügel Maximilian I, Hoelter Philip, Engelhorn Tobias, Jiang Yong, Kuramatsu Joji B, Huttner Hagen B, Dörfler Arnd, Schwab Stefan, Gerner Stefan T
Department of Neurology, University Hospital Erlangen-Nuremberg, Erlangen, Germany.
Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Front Neurol. 2021 Apr 20;12:665791. doi: 10.3389/fneur.2021.665791. eCollection 2021.
Early enteral nutrition (EEN) represents the current standard of care for patients treated in general intensive care units (ICU). Specific nutritional recommendations for patients receiving dedicated neurocritical care are not established. This study investigated associations of EEN with clinical outcomes for patients suffering from intracerebral hemorrhage treated at a neurological ICU (NICU). This retrospective cohort study included patients admitted to the NICU with atraumatic ICH over a 4-year period. Nutritional data, demographic, clinical, radiological, and laboratory characteristics were assessed. EEN was defined as any enteral nutrition within 48 hours after admission. Comparisons were undertaken for patients with EEN vs. those without, further propensity score (PS) matching (caliper 0.2; one: many) was used to account for baseline imbalances. Primary outcome was the modified Rankin Scale (0-3 = favorable, 4-6 = unfavorable) at 12 months, secondary outcomes comprised perihemorrhagic edema (PHE) volume, infectious complications during the hospital stay, and mRS at 3 months, as well as mortality rates at 3 and 12 months. Of 166 ICH-patients treated at the NICU, 51 (30.7%) patients received EEN, and 115 (69.3%) patients received no EEN (nEEN). After propensity score matching, calories delivered from enteral nutrition (EEN 161.4 [106.4-192.3] kcal/day vs. nEEN 0.0 [0.0-0.0], < 0.001) and the total calories (EEN 190.0 [126.0-357.0] kcal/day vs. nEEN 33.6 [0.0-190.0] kcal/day, < 0.001) were significantly different during the first 48 h admitted in NICU. Functional outcome at 12 months (mRS 4-6, EEN 33/43 [76.7%] vs. nEEN, 49/64 [76. 6%]; = 1.00) was similar in the two groups. There were neither differences in mRS at 3 months, nor in mortality rates at 3 and 12 months between the two groups. EEN did not affect incidence of infective complications or gastrointestinal adverse events during the hospital stay; however, EEN was associated with significantly less extent of PHE evolution [maximum absolute PHE (OR 0.822, 95% CI 0.706-0.957, = 0.012); maximum relative PHE (OR 0.784, 95% CI 0.646-0.952, = 0.014)]. In our study, EEN was associated with reduced PHE in ICH-patients treated at a NICU. However, this observation did not translate into improved survival or functional outcome at 3 and 12 months.
早期肠内营养（EEN）是普通重症监护病房（ICU）患者目前的护理标准。对于接受专门神经重症护理的患者，尚无具体的营养建议。本研究调查了在神经重症监护病房（NICU）接受治疗的脑出血患者中，EEN与临床结局之间的关联。这项回顾性队列研究纳入了在4年期间入住NICU的非创伤性脑出血患者。评估了营养数据、人口统计学、临床、放射学和实验室特征。EEN定义为入院后48小时内的任何肠内营养。对接受EEN的患者与未接受EEN的患者进行了比较，并进一步采用倾向评分（PS）匹配（卡尺0.2；一对一匹配）来处理基线不平衡问题。主要结局是12个月时的改良Rankin量表（0 - 3分 = 良好，4 - 6分 = 不良），次要结局包括出血周围水肿（PHE）体积、住院期间的感染并发症、3个月时的改良Rankin量表以及3个月和12个月时的死亡率。在NICU接受治疗的166例脑出血患者中，51例（30.7%）患者接受了EEN，115例（69.3%）患者未接受EEN（非EEN）。倾向评分匹配后，NICU入院后最初48小时内，肠内营养提供的热量（EEN为161.4 [106.4 - 192.3]千卡/天，非EEN为0.0 [0.0 - 0.0]，< 0.001）和总热量（EEN为190.0 [126.0 - 357.0]千卡/天，非EEN为33.6 [0.0 - 190.0]千卡/天，< 0.001）存在显著差异。两组在12个月时的功能结局（改良Rankin量表4 - 6分，EEN组为33/43 [76.7%]，非EEN组为49/64 [76.6%]；P = 1.00）相似。两组在3个月时的改良Rankin量表以及3个月和12个月时的死亡率均无差异。EEN对住院期间感染并发症或胃肠道不良事件的发生率没有影响；然而，EEN与PHE进展程度显著降低相关[最大绝对PHE（OR 0.822，95% CI 0.706 - 0.957，P = 0.012）；最大相对PHE（OR 0.784，95% CI 0.646 - 0.952，P = 0.014）]。在我们的研究中，EEN与NICU治疗的脑出血患者PHE减少相关。然而，这一观察结果并未转化为3个月和12个月时生存率或功能结局的改善。
