Eyer S D, Micon L T, Konstantinides F N, Edlund D A, Rooney K A, Luxenberg M G, Cerra F B
Department of Surgery, University of Minnesota, Minneapolis.
J Trauma. 1993 May;34(5):639-43; discussion 643-4. doi: 10.1097/00005373-199305000-00005.
Enteral feeding very early after trauma has been hypothesized to attenuate the stress response and to improve patient outcome. We tested this hypothesis in a prospective, randomized clinical trial in patients with blunt trauma. Following resuscitation and control of bleeding, 52 patients were randomized to receive early feedings (target, < 24 hours) or late feedings (target, 72 hours). Feeding was given via nasoduodenal feeding tubes. A rapid advance technique was used to achieve full volume and strength within 24 hours (goal, 1.5 g protein/kg.day). Patients who underwent at least 5 days of therapy were considered to have completed the study: 38 in all, 19 in each feeding group. Patients were similar in age, gender, Injury Severity Score, and mean PaO2/FiO2 ratio. The early group, however, had more patients with a PaO2/FiO2 < 150. After feeding began, the amount fed per day was the same in both groups. We found no significant differences in metabolic responses as measured by plasma lactate and urinary total nitrogen, catecholamines, and cortisol. Both groups achieved nitrogen retention. In addition, we found no significant differences in intensive care unit (ICU) days, ventilator days, organ system failure, specific types of infections, or mortality, although the early group had a greater number of total infections. In this study, early enteral feeding after blunt trauma neither attenuated the stress response nor altered patient outcome.
创伤后极早期进行肠内营养被认为可减轻应激反应并改善患者预后。我们在一项针对钝性创伤患者的前瞻性随机临床试验中对这一假设进行了验证。在复苏和控制出血后，52例患者被随机分为早期喂养组（目标时间，<24小时）和晚期喂养组（目标时间，72小时）。通过鼻十二指肠喂养管进行喂养。采用快速推进技术在24小时内达到全量和全强度（目标，1.5 g蛋白质/千克·天）。接受至少5天治疗的患者被视为完成研究：共38例，每个喂养组19例。患者在年龄、性别、损伤严重程度评分和平均动脉血氧分压/吸入氧分数比方面相似。然而，早期组中动脉血氧分压/吸入氧分数<150的患者更多。开始喂养后，两组每天的喂养量相同。我们发现，通过血浆乳酸、尿总氮、儿茶酚胺和皮质醇测量的代谢反应没有显著差异。两组均实现了氮潴留。此外，我们发现重症监护病房（ICU）住院天数、呼吸机使用天数、器官系统衰竭、特定类型感染或死亡率方面没有显著差异，尽管早期组的总感染例数更多。在本研究中，钝性创伤后早期肠内营养既未减轻应激反应，也未改变患者预后。
