重症神经损伤患者胃对比小肠喂养：多中心观察性研究结果

　　背景：旨在评估与小肠喂养相比，胃管喂养对神经损伤的重症患者的营养和临床预后的影响。

　　资料与方法：该前瞻性的观察性研究在国际范围内纳入了353个重症监护病房（ICU）。入选标准为在ICU内有神经科诊断并需要机械通气，同时进行肠内营养（EN）至少3天的重症患者。参与的中心需要提供以下数据，其中包括患者特征，营养支持的方法，以及之后60天的效果。对接受胃管喂养和小肠喂养的患者进行了对比。在调整分析中使用的协变量包括年龄，性别，体质指数，以及急性生理和慢性健康评估Ⅱ的评分。

　　结果：在符合我们入选标准的1691例患者中，1407例（94.1%）接受胃管喂养，88例（5.9%）接受小肠喂养。从EN中获得热量最高的是胃管喂养组（分别为60.2%和52.3%，非调整分析；P=0.001），但在调整模型组中无统计学意义（P=0.428）。EN中断的原因主要是胃管喂养组胃肠道（GI）并发症的发生较多（19.6%比4.7%，非调整模型组；P=0.015）。在调整了混杂因素之后，机械通气的中止率（风险比[HR]：0.86；95%可信区间[CI]：0.66～1.12；P=0.270）或从ICU存活至出院的概率（HR：0.94；95%CI：0.72～1.23；P=0.641）以及住院时间（HR：1.16；95%CI：0.87～1.55；P=0.307）的差异均无统计学有意义。

　　结论：虽然胃管喂养可能由于胃肠道并发症而中止EN的可能性较高，但胃管喂养可以获得更充足的营养，而两种方法对临床预后的影响无差异。

JPEN J Parenter Enteral Nutr. 2015 Nov;39(8):910-6.

Gastric vs Small Bowel Feeding in Critically Ill Neurologically Injured Patients: Results of a Multicenter Observational Study.

Saran D, Brody RA, Stankorb SM, Parrott SJ, Heyland DK.

School of Health Related Professions, Rutgers, The State University of New Jersey, Newark, New Jersey.

Food & Nutrition Services, Fraser Health Authority, British Columbia, Canada.

Clinical Evaluation Research Unit, Kingston General Hospital, Ontario, Canada.

Department of Medicine, Queen's University, Kingston, Ontario, Canada.

BACKGROUND: To evaluate gastric compared with small bowel feeding on nutrition and clinical outcomes in critically ill, neurologically injured patients.

MATERIALS AND METHODS: International, prospective observational studies involving 353 intensive care units (ICUs) were included. Eligible patients were critically ill, mechanically ventilated with neurological diagnoses who remained in the ICU and received enteral nutrition (EN) exclusively for at least 3 days. Sites provided data, including patient characteristics, nutrition practices, and 60-day outcomes. Patients receiving gastric or small bowel feeding were compared. Covariates including age, sex, body mass index, and Acute Physiology and Chronic Health Evaluation II score were used in the adjusted analyses.

RESULTS: Of the 1691 patients who met our inclusion criteria, 1407 (94.1%) received gastric feeding and 88 (5.9%) received small bowel feeding. Adequacy of calories from EN was highest in the gastric group (60.2% and 52.3%, respectively, unadjusted analysis; P = .001), but this was not significant in the adjusted model (P = .428). The likelihood of EN interruptions due to gastrointestinal (GI) complications was higher for the gastric group (19.6% vs 4.7%, unadjusted model; P = .015). There were no significant differences in the rate of discontinuation of mechanical ventilation (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.66-1.12; P = .270) or the rate of being discharged alive from the ICU (HR, 0.94; 95% CI, 0.72-1.23; P = .641) and hospital (HR, 1.16; 95% CI, 0.87-1.55; P = .307) after adjusting for confounders.

CONCLUSIONS: Despite a higher likelihood of EN interruptions due to GI complications, gastric feeding may be associated with better nutrition adequacy, but neither route is associated with better clinical outcomes.

KEYWORDS: brain injuries; critical care; enteral access; enteral nutrition; head injury; nutrition; nutrition support practice

PMID: 24947058

DOI: 10.1177/0148607114540003