Association between parenteral nutrition in the early phase and outcomes in patients with abdominal trauma undergoing emergency laparotomy: A retrospective nationwide study
Association between parenteral nutrition in the early phase and outcomes in patients with abdominal trauma undergoing emergency laparotomy: A retrospective nationwide study
复制标题
早期肠外营养与接受紧急剖腹手术的腹部创伤患者结局之间的关系：一项回顾性全国性研究
DOI：
10.1016/j.clnesp.2020.10.018
复制
发表时间：
2021
影响因子：
3
通讯作者：
Yasunaga Hideo
中科院分区：
文献类型：
--
作者：
Otaka Shunichi;Aso Shotaro;Matsui Hiroki;Fushimi Kiyohide;Yasunaga Hideo
背景与目的剖腹手术后创伤患者常进行早期肠外营养。然而，在这一人群中，肠外营养在早期的临床益处仍然未知。我们调查了急诊剖腹手术的创伤患者早期肠外营养与预后的关系。方法使用2010年7月至2018年3月的日本全国数据库，我们确定了入院时接受紧急剖腹手术、入院时需要机械通气、入院后2天内未接受肠内营养的创伤患者。我们进行了重叠权重分析，以比较早期接受和不接受肠外营养的患者的住院结果。主要观察指标为机械通气的持续时间。次要结局是住院时间、总住院费用、气管切开术、医院获得性肺炎和全因28天住院死亡率。结果共纳入成人患者1700例。早期肠外营养与机械通气持续时间（差值为- 0.4天，95%可信区间为- 2.9至2.2）、住院时间（差值为1.3天，95%可信区间为- 5.0至7.5）、住院总费用（差值为730美元，95%可信区间为- 2911至4370美元）、气管造口术（风险差值为0.01,95%可信区间为- 0.03至0.05）、医院获得性肺炎(风险差值为- 0.01；95%可信区间，- 0.05至0.03)，或全因住院28天死亡率（风险差为0.02；95%可信区间，- 0.01至0.06）。结论急诊剖腹手术创伤患者早期肠外营养与较好的住院预后无相关性。
Background & aimsParenteral nutrition in the early phase is often performed for patients with trauma who have undergone laparotomy. However, the clinical benefits of parenteral nutrition in the early phase in this population remain unknown. We investigated the association of parenteral nutrition in the early phase with outcomes in patients with trauma who underwent emergency laparotomy.MethodsUsing a Japanese nationwide database from July 2010 to March 2018, we identified patients with trauma who underwent emergency laparotomy on admission to the hospital, required mechanical ventilation on admission, and did not receive enteral nutrition within 2 days after admission. We performed an overlap weights analysis to compare in-hospital outcomes between patients with and without parenteral nutrition in the early phase. The primary outcome was the duration of mechanical ventilation. The secondary outcomes were the length of hospital stay, total hospitalization cost, tracheostomy, hospital-acquired pneumonia, and all-cause 28-day in-hospital mortality.ResultsIn total, 1700 adult patients were included. There were no significant associations between parenteral nutrition in the early phase and the duration of mechanical ventilation (difference, −0.4 days; 95% confidence interval, −2.9 to 2.2), length of hospital stay (difference, 1.3 days; 95% confidence interval, −5.0 to 7.5), total hospitalization cost (difference, US$ 730; 95% confidence interval, −2911 to 4370), tracheostomy (risk difference, 0.01; 95% confidence interval, −0.03 to 0.05), hospital-acquired pneumonia (risk difference, −0.01; 95% confidence interval, −0.05 to 0.03), or all-cause 28-day in-hospital mortality (risk difference, 0.02; 95% confidence interval, −0.01 to 0.06).ConclusionsParenteral nutrition in the early phase for patients with trauma undergoing emergency laparotomy was not associated with better in-hospital outcomes.