BENEFITS OF IMMEDIATE JEJUNOSTOMY FEEDING AFTER MAJOR ABDOMINAL-TRAUMA - A PROSPECTIVE, RANDOMIZED STUDY
BENEFITS OF IMMEDIATE JEJUNOSTOMY FEEDING AFTER MAJOR ABDOMINAL-TRAUMA - A PROSPECTIVE, RANDOMIZED STUDY
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DOI：
10.1097/00005373-198610000-00003
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发表时间：
1986-10-01
影响因子：
--
通讯作者：
JONES, TN
中科院分区：
文献类型：
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作者：
MOORE, EE;JONES, TN
伤后立即营养支持的益处仍然不明确。75名连续接受紧急剖腹术的患者，腹部创伤指数（A.T.I.）> 15例前瞻性随机分为对照组（前5天不补充营养）或肠内喂养组。肠内患者行针导管空肠造口术（N. C. J.）在剖腹手术时放置，在18小时开始持续输注元素饮食（Vivonex HN），并在72小时内增加到3，000 ml/天（3，000 kcal，20 gm N2）。对照组和肠内喂养组在人口统计学特征、创伤机制、休克、结肠损伤、脾切除术、A.T.I.初步营养评估。20例（63%）肠内患者维持元素饮食> 5天; 4例（12%）需要全肠外营养（T.P.N.）。9例（29%）对照患者需要T.P.N.肠内营养组氮平衡明显改善（p < 0.001）。 虽然内脏蛋白标志物和总体并发症发生率没有显著差异，但对照组（7例腹腔感染和2例肺炎）的脓毒症发病率高于肠内喂养患者（3例腹腔脓肿）（p < 0.025）。A.T.I.患者分析15-40显示对照组7例（26%）发生败血症，而肠内喂养组1例（4%）发生败血症（p < 0.01）。我们的临床经验表明，在严重腹部创伤后立即通过N. C. J.进行术后肠内营养的可行性，并表明这种早期营养可减少危重患者的脓毒症并发症。
Benefits of immediate postinjury nutritional support remain ill defined. Seventy-five consecutive patients undergoing emergent celiotomy with an abdominal trauna index (A.T.I.) > 15 were randomized prospectively to a control group (no suplemental nutrition during first 5 days) or enteral-fed group. The enteral patients had a needle catheter jejunostomy (N.C.J.) placed at laparotomy with the constant infusion of an elemental diet (Vivonex HN) begun at 18 hours and advanced to 3,000 ml/day (3,000 kcal, 20 gm N2) within 72 hours. Control and enteral-fed groups were comparable with respect to demographic features, trauma mechanism, shock, colon injury, splenectomy, A.T.I., and initial nutritional assessment. Twenty (63%) of the enteral patients were maintained on the elemental diet > 5 days; four (12%) needed total parenteral nutrition (T.P.N.). Nine (29%) of the control patients required T.P.N. Nitrogen balance was markedly improved (p < 0.001) in the enteral-fed group. Although visceral protein markers and overall complication rate were not significantly different, septic morbidity was greater (p < 0.025) in the control group (abdominal infection in seven and pneumonia in two) compared to the enteral-fed patients (abdominal abscess in three). Analysis of patients with A.T.I. 15-40 disclosed sepsis in seven (26%) of the control versus one (4%) of the enteral-fed group (p < 0.01). Our clinical experience demonstrates the feasibiliity of immediate postoperative enteral feeding via N.C.J. after major abdominal trauma, and suggests this early nutrition reduces septic complications in critically injured patients.