危重症儿童幽门后与胃内肠内营养比较：单中心回顾性队列研究。
Postpyloric vs gastric enteral nutrition in critically ill children: A single-center retrospective cohort study.
机构信息
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA.
出版信息
JPEN J Parenter Enteral Nutr. 2023 May;47(4):494-500. doi: 10.1002/jpen.2482. Epub 2023 Feb 20.
BACKGROUND
We aimed to describe enteral nutrition (EN) delivery in patients receiving postpyloric EN (PPEN) vs gastric EN (GEN).
METHODS
Single-center retrospective study including patients aged <21 years admitted to an intensive care unit in a pediatric quaternary care hospital for ≧48 h who received PPEN or GEN as a first approach, as guided by a nutrition algorithm. PPEN patients were 1:1 propensity score matched to GEN patients on demographics, clinical characteristics, and disease severity. Days to EN initiation from admission, percentage of EN adequacy (delivered EN volume/prescribed EN volume) on days 1-3 and 7 after EN initiation, and time to achieving 60% of prescribed EN volume were compared between the two groups using Wilcoxon Mann-Whitney tests and a Cox proportional hazards model. Data are presented as median (IQR1, IQR3).
RESULTS
Forty-six PPEN and 46 GEN patients were matched. Median time to EN initiation was 3.25 (2, 6.8) days for PPEN and 4.15 (1.5, 7.1) days for GEN (P = 0.6). Percentage of EN adequacy was greater for PPEN than GEN patients (day 1 PPEN 59.4% [18.8, 87.5] vs GEN 21.1% [7.8, 62.8], day 2 PPEN 54.3% [16.7, 95.8] vs GEN 24% [5.4, 56.7], day 3 PPEN 65.4% [14.7, 100] vs GEN 16% [0, 64.6], day 7 PPEN 77.8% [11.1, 100] vs GEN 13.8% [0, 74.5]; P < 0.05). PPEN patients had greater likelihood of achieving 60% of their prescribed EN volume than GEN patients (hazard ratio 1.84, 95% CI 1.07-3.15; P = 0.028).
CONCLUSION
PPEN was associated with greater EN delivery compared with GEN.
背景
本研究旨在描述接受幽门后肠内营养（PPEN）与胃内肠内营养（GEN）的患者的肠内营养（EN）输送情况。
方法
这是一项单中心回顾性研究，纳入了 21 岁以下因疾病入住儿科四级医院重症监护病房且需要接受肠内营养治疗且入住时间≧48 小时的患者。这些患者均按照营养算法首先接受 PPEN 或 GEN 治疗。将 PPEN 患者与 GEN 患者按照人口统计学、临床特征和疾病严重程度进行 1:1 倾向评分匹配。使用 Wilcoxon 曼-惠特尼检验和 Cox 比例风险模型比较两组患者从入院到开始 EN 治疗的天数、开始 EN 治疗后第 1-3 天和第 7 天的 EN 充足率（给予的 EN 量/规定的 EN 量）以及达到规定 EN 量的 60%所需的时间。数据以中位数（IQR1，IQR3）表示。
结果
共匹配了 46 例 PPEN 和 46 例 GEN 患者。PPEN 组从入院到开始 EN 治疗的中位时间为 3.25（2，6.8）天，GEN 组为 4.15（1.5，7.1）天（P=0.6）。PPEN 组的 EN 充足率大于 GEN 组（第 1 天 PPEN 组为 59.4%[18.8，87.5]，GEN 组为 21.1%[7.8，62.8]；第 2 天 PPEN 组为 54.3%[16.7，95.8]，GEN 组为 24%[5.4，56.7]；第 3 天 PPEN 组为 65.4%[14.7，100]，GEN 组为 16%[0，64.6]；第 7 天 PPEN 组为 77.8%[11.1，100]，GEN 组为 13.8%[0，74.5]；P<0.05）。与 GEN 组相比，PPEN 组达到规定 EN 量的 60%的可能性更高（风险比 1.84，95%CI 1.07-3.15；P=0.028）。
结论
与 GEN 相比，PPEN 与更高的 EN 输送相关。
Zotero 插件