Department of Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guo Xue Road, Chengdu 610041, China.
Administrative Office, West China Tianfu Hospital, Sichuan University, Chengdu 610213, China.
Nutrients. 2022 Dec 19;14(24):5393. doi: 10.3390/nu14245393.
(1) Background: Studies on the long-term patterns of using vasopressors in patients with shock and their correlations with the risk of feeding intolerance (FI) are limited. This study aimed to characterize the norepinephrine equivalent dose (NEQ) trajectories and explore its correlations with FI in patients with shock. (2) Methods: This study prospectively enrolled patients with shock, who received vasopressors from August 2020 to June 2022. The Growth Mixed Model (GMM) was used to traverse longitudinal NEQ data at six-hour intervals and identify the latent trajectories of NEQ use in these patients. Cox proportional hazards regression models were used to examine the correlations of NEQ trajectories with FI. (3) Results: This study included a total of 210 patients with shock recruited from August 2020 to June 2022. Four trajectories of NEQ dose were identified and characterized by low-dose stable NEQ (L-NEQ, n = 98), moderate-dose stable NEQ (M-NEQ, n = 74), high-dose stable NEQ (H-NEQ, n = 21), and rapidly rising NEQ (R-NEQ, n = 17), with NEQ doses of 0.2, 0.4, 0.4, and 0.5 µg/kg/min at enteral nutrition (EN) initiation, respectively. The incidences of FI were 37.76%, 67.57%, 80.95%, and 76.47% in the L-NEQ, M-NEQ, H-NEQ, and R-NEQ groups, respectively (p < 0.001). As compared to the L-NEQ group, the risk of FI occurrence increased in the M-NEQ, H-NEQ, and R-NEQ groups (all p < 0.05). (4) Conclusions: The risk of FI was significantly associated with NEQ trajectories. It might be appropriate to initiate EN when the NEQ dose is stabilized below 0.2 µg/kg/min in patients with shock.
（1）背景：关于休克患者使用血管加压素的长期模式及其与喂养不耐受（FI）风险的相关性的研究有限。本研究旨在描述去甲肾上腺素等效剂量（NEQ）轨迹，并探讨其与休克患者 FI 的相关性。（2）方法：本研究前瞻性纳入 2020 年 8 月至 2022 年 6 月期间接受血管加压素治疗的休克患者。采用生长混合模型（GMM）以 6 小时为间隔遍历纵向 NEQ 数据，并确定这些患者 NEQ 使用的潜在轨迹。采用 Cox 比例风险回归模型检验 NEQ 轨迹与 FI 的相关性。（3）结果：本研究共纳入 2020 年 8 月至 2022 年 6 月期间收治的 210 例休克患者。确定并描述了 4 种 NEQ 剂量轨迹，分别为低剂量稳定 NEQ（L-NEQ，n = 98）、中剂量稳定 NEQ（M-NEQ，n = 74）、高剂量稳定 NEQ（H-NEQ，n = 21）和快速升高 NEQ（R-NEQ，n = 17），肠内营养（EN）起始时的 NEQ 剂量分别为 0.2、0.4、0.4 和 0.5 µg/kg/min。L-NEQ、M-NEQ、H-NEQ 和 R-NEQ 组的 FI 发生率分别为 37.76%、67.57%、80.95%和 76.47%（p < 0.001）。与 L-NEQ 组相比，M-NEQ、H-NEQ 和 R-NEQ 组 FI 发生率升高（均 p < 0.05）。（4）结论：FI 的发生风险与 NEQ 轨迹显著相关。休克患者的 NEQ 剂量稳定在 0.2 µg/kg/min 以下时，可能适合开始 EN。
