A multi-center trial of the effects of oral nutritional supplementation in critically ill older inpatients
A multi-center trial of the effects of oral nutritional supplementation in critically ill older inpatients
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DOI：
10.1016/s0899-9007(99)00227-0
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发表时间：
2000-01-01
期刊：
影响因子：
4.4
通讯作者：
Dartigues, JF
中科院分区：
文献类型：
--
作者：
Bourdel-Marchasson, I;Barateau, M;Dartigues, JF
本研究的目的是评估营养补充剂对危重老年患者的饮食摄入和压疮发展的影响。这项多中心试验涉及 19 个病区，根据专业和招募危重老年患者进行分层；随机选取9个病区进行营养干预（营养干预组），每日口服2剂补充剂，每次200 kcal，持续15 d。前瞻性记录 I 级（红斑）、II 级（浅表破损皮肤）和 III 级（皮下病变）的压疮发生率，持续 15 天。通过使用以季度为单位的估计值来监测营养摄入量，并通过与体重测量进行比较来验证。 672 名年龄超过 65 岁的受试者中，营养干预组有 295 名受试者，对照组有 377 名受试者。患者年龄、性别比、C反应蛋白相似，与对照组相比，营养干预组脑卒中、心力衰竭、呼吸困难患者较多，有跌倒、谵妄、下肢骨折、消化系统疾病患者较少。根据诺顿评分，营养干预组患压疮的风险较低，但依赖性较低（昆兹曼评分），并且血清白蛋白水平较低。试验期间，营养干预组的能量和蛋白质摄入量较高（第 2 天：1081 +/- 595 kcal 对比 957 +/- 530 kcal，P = 0.006；对照组 45.9 +/- 27.8 g 蛋白质对比 38.3 +/- 23.8 g 蛋白质，P < 0.001）。 15天时，营养干预组压疮的累积发生率为40.6%，而对照组为47.2%。 Ⅰ级病例占病例总数的比例为90%。考虑到所有诊断、潜在危险因素和病房内相关性的多变量分析表明，在此期间发生压疮的独立危险因素是：基线血清白蛋白水平，每降低1 g/L：1.05（95%置信区间：1.02至1.07，P < 0.001）； Kuntzmann 基线评分，每增加 1 分：1.22（0.32 至 4.58，P = 0.003）；下肢骨折：2.68（1.75～4.11，P<0.001）；诺顿评分 < 10 与 > 14：1.28（1.01 至 1.62，P = 0.04）；属于对照组：1.57（1.03至2.38，P = 0.04）。总之，通过系统使用口服补充剂可以增加危重老年受试者的饮食摄入量，这种干预措施与降低压疮发生风险相关。 (C) 爱思唯尔科学公司。2000。
The purpose of this study was to assess the effect of nutritional supplementation on dietary intake and on pressure ulcer development in critically ill older patients. The multi-center trial involved 19 wards stratified according to speciality and recruitment for critically ill older patients; 9 wards were randomly selected for nutritional intervention (nutritional intervention group), consisting of the daily distribution of two oral supplements, with each supplement containg 200 kcal, for 15 d. Pressure ulcer incidence was prospectively recorded for grades I (erythema), II (superficial broken skin), and III (subcutaneous lesion) for 15 d. Nutritional intake was monitored by using estimates in units of quarters validated by comparison with weight measurement. There were 672 subjects older than 65 y, and 295 were in the nutritional intervention group versus 377 in the control group. The patients were similar for age, sex ratio, and C-reactive protein, In comparison with the control group, the nutritional intervention group included more patients with stroke, heart failure, and dyspnea and fewer with antecedent falls, delirium, lower limb fractures, and digestive disease. The nutritional intervention group had a lower risk of pressure ulcers according to the Norton score but was less dependent (Kuntzman score) and had a lower serum albumin level. During the trial, energy and protein intakes were higher in the nutritional intervention group (day 2: 1081 +/- 595 kcal versus 957 +/- 530 kcal, P = 0.006; 45.9 +/- 27.8 g protein versus 38.3 +/- 23.8 g protein in the control group, P < 0.001). At 15 d, the cumulative incidence of pressure ulcers was 40.6% in the nutritional intervention group versus 47.2% in the control group. The proportion of grade I cases relative to the total number of cases was 90%. Multivariate analysis, taking into account all diagnoses, potential risk factors, and the intra-ward correlation, indicated that the independent risk factors of developing a pressure ulcer during this period were: serum albumin level at baseline, for 1 g/L decrease: 1.05 (95% confidence interval: 1.02 to 1.07, P < 0.001); Kuntzmann score at baseline, for 1-point increase: 1.22 (0.32 to 4.58, P = 0.003); lower limb fracture: 2.68 (1.75 to 4.11, P < 0.001); Norton score < 10 versus > 14: 1.28 (1.01 to 1.62, P = 0.04); and belonging to the control group: 1.57 (1.03 to 2.38, P = 0.04). In conclusion it was possible to increase the dietary intake of critically ill elderly subjects by systematic use of oral supplements, This intervention was associated with a decreased risk of pressure ulcer incidence. (C) Elsevier Science Inc. 2000.