Effects of continuous versus bolus infusion of enteral nutrition in critical patients.
Effects of continuous versus bolus infusion of enteral nutrition in critical patients.
复制标题
危重患者连续输注与推注肠内营养的效果。
DOI：
10.1590/s0041-87812003000100003
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发表时间：
2003
期刊：
影响因子：
--
通讯作者：
I. Ceconello
中科院分区：
文献类型：
--
作者：
L. Serpa;M. Kimura;J. Faintuch;I. Ceconello
目的
肠内营养是消化功能可接受且无法口服进食的危重患者的首选支持方式，但连续给药与间歇给药的优点存在争议。为了确定每种技术的优点和并发症，对匹配的受试者进行了一项前瞻性对照研究。
患者和方法
连续 28 名肠内喂养候选人被分为 2 组（每组 14 人），并进行诊断和 APACHE II 评分匹配。通过电子泵通过鼻胃管以 25 kcal/kg/天的比例施用商业免疫刺激聚合物饮食，或者每 3 小时一次 1 小时推注（第一组），或者在 3 天的时间内连续 24 小时（第二组）。每天至少进行一次人体测量、生化测量、记录给药和其他治疗、胸部X光检查、腹围测量、胃残留监测以及临床和营养评估。该方案的主要测量结果是腹胀和肺误吸的频率，以及提供所需营养量的功效。
结果
近一半的人群（46.4%）至少有 1 次出现高胃残留，但只有 1 次确诊发生肺误吸（3.6%）。两组均出现中等数量的并发症，但没有差异。第二组第一天的食物输入量较多（大约有 20% 的差异），但到了第三天，与规定饮食相比，两组的总供给量都出现了类似的小缺口，约为 10%。
结论
两种给药方式都允许实际有效地管理饮食，经常出现异常情况，但很少出现临床重大问题。两组在这方面相似，没有统计学差异，可能是因为在两种情况下都采用了细致的技术、仔细的监测、严格的患者匹配以及保守的饮食量。应对其他人群、诊断组和饮食处方进行进一步研究，以阐明这些常用喂养方式之间的差异。
PURPOSE
Enteral alimentation is the preferred modality of support in critical patients who have acceptable digestive function and are unable to eat orally, but the advantages of continuous versus intermittent administration are surrounded by controversy. With the purpose of identifying the benefits and complications of each technique, a prospective controlled study with matched subjects was conducted.
PATIENTS AND METHODS
Twenty-eight consecutive candidates for enteral feeding were divided into 2 groups (n = 14 each) that were matched for diagnosis and APACHE II score. A commercial immune-stimulating polymeric diet was administered via nasogastric tube by electronic pump in the proportion of 25 kcal/kg/day, either as a 1-hour bolus every 3 hours (Group I), or continuously for 24 hours (Group II), over a 3-day period. Anthropometrics, biochemical measurements, recording of administered drugs and other therapies, thorax X-ray, measurement of abdominal circumference, monitoring of gastric residue, and clinical and nutritional assessments were performed at least once daily. The principal measured outcomes of this protocol were frequency of abdominal distention and pulmonary aspiration, and efficacy in supplying the desired amount of nutrients.
RESULTS
Nearly half of the total population (46.4%) exhibited high gastric residues on at least 1 occasion, but only 1 confirmed episode of pulmonary aspiration occurred (3.6%). Both groups displayed a moderate number of complications, without differences. Food input during the first day was greater in Group II (approximately 20% difference), but by the third day, both groups displayed similarly small deficits in total furnished volume of about 10%, when compared with the prescribed diet.
CONCLUSIONS
Both administration modalities permitted practical and effective administration of the diet with frequent registered abnormalities but few clinically significant problems. The two groups were similar in this regard, without statistical differences, probably because of meticulous technique, careful monitoring, strict patient matching, and conservative amounts of diet employed in both situations. Further studies with additional populations, diagnostic groups, and dietetic prescriptions should be performed in order to elucidate the differences between these commonly used feeding modalities.