Wittstock Matthias, Kästner Matthias, Kolbaske Stephan, Sellmann Tina, Porath Katrin, Patejdl Robert
Department of Neurology, University Medical Center Rostock, Rostock, Germany.
Oscar Langendorff Institute of Physiology, University Medical Center Rostock, Rostock, Germany.
Front Nutr. 2022 Feb 3;8:742656. doi: 10.3389/fnut.2021.742656. eCollection 2021.
Delayed gastric emptying contributes to complications as aspiration or malnutrition. Among patients suffering from acute neurological diseases, motility disorders are prevalent but poorly understood. Thus, methods to measure gastric emptying are required to allow for appropriate adaptions of individual enteral nutrition algorithms. For enterally fed patients repetitive concentration measurements of gastric content have been proposed to assess gastric emptying. This approach can be used to calculate the gastric residual volume (GRV) and transport of nutrition formula (NF), but it has not yet been implemented in clinical routine. The aim of this study was to investigate whether refractometry or other likewise straightforward analytical approaches produce the best results under conditions mimicking the gastric milieu. We measured NF in different known concentrations, either diluted in water or in simulated gastric fluid (SGF), with each of the following methods: refractometer, handheld glucose meter, and Bradford protein assay. Then, in enterally fed patients suffering from acute neurological disease, we calculated GRVs and nutrition transport and tested possible associations with clinical parameters. In water dilution experiments, NF concentrations could be assessed with the readout parameters of all three methods. Refractometry yielded the most precise results over the broadest range of concentrations and was biased least by the presence of SGF (detection range for Fresubin original fibre, given as volume concentration/normalized error of regression slope after incubation with water or SGF: 0-100 vs. 0-100%/0.5 vs. 3.9%; glucose-measurement: 5-100 vs. 25-100%/7.9 vs. 6.1%; Bradford-assay: 0-100 vs. 0-100%/7.8 vs. 15.7%). Out of 28 enterally fed patients, we calculated significant slower nutrition transport in patients with higher blood glucose (Rho -0.391; = 0.039) and in patients who received high-dose sufentanil (Rho -0.514; = 0.005). Also, the calculated nutrition transport could distinguish patients with and without feeding intolerance (Median 6 vs. 17 ml/h; Mann-Whitney test: = 0.002). The results of our study prove that serial refractometry is a suitable and cost-effective method to assess gastric emptying and to enhance research on gastrointestinal complications of stroke.
胃排空延迟会导致诸如误吸或营养不良等并发症。在患有急性神经系统疾病的患者中，运动功能障碍很常见，但了解甚少。因此，需要测量胃排空的方法，以便对个体肠内营养算法进行适当调整。对于接受肠内喂养的患者，已有人提出通过重复测量胃内容物浓度来评估胃排空。这种方法可用于计算胃残余量（GRV）和营养配方（NF）的转运情况，但尚未在临床常规中实施。本研究的目的是调查在模拟胃环境的条件下，折射测定法或其他同样简单的分析方法是否能产生最佳结果。我们用以下每种方法测量了不同已知浓度的NF，这些NF分别用水或模拟胃液（SGF）稀释：折射仪、手持式血糖仪和Bradford蛋白测定法。然后，在患有急性神经系统疾病的肠内喂养患者中，我们计算了GRV和营养转运情况，并测试了其与临床参数的可能关联。在水稀释实验中，所有三种方法的读数参数均可用于评估NF浓度。折射测定法在最宽的浓度范围内产生了最精确的结果，并且受SGF存在的影响最小（Fresubin original fibre的检测范围，以体积浓度/与水或SGF孵育后的回归斜率标准化误差表示：0 - 100 vs. 0 - 100%/0.5 vs. 3.9%；葡萄糖测量：5 - 100 vs. 25 - 100%/7.9 vs. 6.1%；Bradford测定法：0 - 100 vs. 0 - 100%/7.8 vs. 15.7%）。在28例肠内喂养患者中，我们发现血糖较高的患者（Rho -0.391；P = 0.039）和接受高剂量舒芬太尼的患者（Rho -0.514；P = 0.005）营养转运明显较慢。此外，计算得出的营养转运情况能够区分有无喂养不耐受的患者（中位数分别为6 vs. 17 ml/h；Mann-Whitney检验：P = 0.002）。我们的研究结果证明，连续折射测定法是一种合适且经济高效的方法，可用于评估胃排空并加强对中风胃肠道并发症的研究。
