Keohane P P, Attrill H, Love M, Frost P, Silk D B
Br Med J (Clin Res Ed). 1984 Mar 3;288(6418):678-80. doi: 10.1136/bmj.288.6418.678.
One hundred and eighteen patients with normal gastrointestinal function were randomly allocated to one of three feeding regimens in a double blind study to determine the relation between the tonicity of the diet and gastrointestinal side effects related to the diet and to evaluate the efficacy of "starter" regimens in reducing gastrointestinal side effects during enteral nutrition. Patients received a hypertonic diet with an osmolality of 430 mmol (mosmol)/kg (group 1), the same diet but with the osmolality increasing from 145 to 430 mmol/kg over the first four days (group 2), or an isotonic diet (300 mmol/kg) (group 3). All diets were prepared aseptically and administered by 24 hour nasogastric infusion. The mean daily nitrogen intake in group 1 was significantly greater (p less than 0.05) than that in both groups 2 and 3, and the mean overall daily nitrogen balance was significantly better (p less than 0.05) in group 1 than groups 2 and 3. The incidence of side effects related to the diet was similar in all three groups, but diarrhoea was significantly (p less than 0.001) associated with concurrent treatment with antibiotics. These findings show that undiluted hypertonic diet results in significantly better nitrogen intake and balance, that starter regimens reduce nutrient intake but not symptoms, and that diarrhoea is significantly related to treatment with antibiotics and not to administration of an undiluted hypertonic polymeric diet.
118名胃肠功能正常的患者在一项双盲研究中被随机分配至三种喂养方案之一，以确定饮食的渗透压与饮食相关的胃肠道副作用之间的关系，并评估“起始”方案在减少肠内营养期间胃肠道副作用方面的疗效。患者分别接受渗透压为430毫摩尔（毫渗摩尔）/千克的高渗饮食（第1组）、相同饮食但在前四天渗透压从145毫摩尔/千克增至430毫摩尔/千克的饮食（第2组）或等渗饮食（300毫摩尔/千克）（第3组）。所有饮食均无菌制备，并通过24小时鼻胃输注给药。第1组的平均每日氮摄入量显著高于第2组和第3组（p<0.05），第1组的平均总体每日氮平衡显著优于第2组和第3组（p<0.05）。三组中与饮食相关的副作用发生率相似，但腹泻与同时使用抗生素显著相关（p<0.001）。这些研究结果表明，未稀释的高渗饮食可显著提高氮摄入量和平衡，起始方案会减少营养摄入但不会减轻症状，腹泻与抗生素治疗显著相关，而与未稀释的高渗聚合饮食给药无关。
