Enteral nutrition-related gastrointestinal complications in critically ill patients: A multicenter study
Enteral nutrition-related gastrointestinal complications in critically ill patients: A multicenter study
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DOI：
10.1097/00003246-199908000-00006
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发表时间：
1999-08-01
影响因子：
8.8
通讯作者：
Montejo, JC
中科院分区：
文献类型：
--
作者：
Montejo, JC
目的：评价接受肠内营养的危重患者的胃肠道并发症（GIC）的频率，并评估其对营养管理的影响及其与患者结局的关系。设计：多中心，前瞻性队列研究。设置：西班牙37个多学科重症监护病房（ICU）。患者：前瞻性队列的400例连续患者入住ICU和接受肠内nutritions.Interventions：非干预性，后续研究。测量和主要结果：肠内营养相关的GIC和他们的管理是由共识数据收集前定义。记录了一组与肠内营养给药和GIC存在相关的变量。在为期1个月的研究期间，入组了400例患者，共分析了3，778个肠内喂养日。平均肠内营养时间为9.6 ± 0.4天。从入住ICU到开始肠内喂养的平均时间为3.1 ± 0.2天。共265名患者（66.2%）接受了标准聚合物配方，132名（33.8%）接受了疾病特异性配方。肠内喂养主要通过鼻胃管进行（91%）。251例患者出现一个或多个GIC GIC的发生率依次为：高胃残留39%、便秘15.7%、腹泻14.7%、腹胀13.2%、呕吐12.2%、腹泻14.7%、腹泻14. 15.2%的患者因不可控制的GIC而停用肠内营养。体积比每日计算给药体积与处方体积的比值，并将其用作饮食给药疗效的指标。GIC患者的体积比低于无GIC患者（63.1 +/- 1.2% vs. 93.3 +/- 0.3%）（p <0.001），住院时间较长（20.6 ± 1.2 vs. 15.2 ± 1.3天）（p <0.01），死亡率较高（31% vs. 16.1%）结论：危重病人肠内营养相关GIG发生率高，以高胃残留最常见。这些并发症减少了营养摄入，如果持续存在，可能会使患者暴露于营养不良，肠内喂养胃肠道不耐受似乎对延长ICU住院时间和增加患者死亡率具有演变性影响。
Objective: To evaluate the frequency of gastrointestinal complications (GICs) in a prospective cohort of critically ill patients receiving enteral nutrition and to assess its effect on nutrient administration and its relationship to the patient's outcome.Design: Multicenter, prospective cohort study.Setting: Thirty-seven multidisciplinary intensive care units (ICUs) in Spain.Patients: Prospective cohort of 400 consecutive patients admitted to the ICU and receiving enteral nutrition.Interventions: Noninterventional, follow-up study.Measurements and Main Results: Enteral nutrition-related GICs and their management were defined by consensus before data collection. A set of variables related to enteral nutrition administration and the presence of GICs was recorded. During the 1-month study period, 400 patients were enrolled, and a total of 3,778 enteral feeding days were analyzed. The mean time of enteral nutrition was 9.6 +/- 0.4 days. Mean elapsed time from ICU admission to the start of enteral feeding was 3.1 +/- 0.2 days. A total of 265 patients (66.2%) received a standard polymeric formula, and 132 (33.8%) received a disease-specific one, Enteral feeds were administered mainly through a nasogastric tube (91%). One or more GICs were presented by 251 patients (62.8%) during the feeding course, The frequency of each particular GIC was as follows: high gastric residuals, 39%; constipation, 15.7%; diarrhea, 14.7%; abdominal distention, 13.2%; vomiting, 12.2%; and regurgitation, 5.5%, Enteral nutrition withdrawal as a consequence of noncontrollable GICs occurred in 15.2% of patients. The volume ratio (expressed as the ratio between administered and prescribed volumes) was calculated daily and was used as an index of diet administration efficacy, Patients with GICs had a lower volume ratio than did patients without GICs (63.1 +/- 1.2% vs. 93.3 +/- 0.3%) (p < .001), a longer length of stay (20.6 +/- 1.2 vs. 15.2 +/- 1.3 days) (p < .01), and higher mortality (31% vs. 16.1%) (p < .001),Conclusions: The frequency of enteral nutrition-related GICs in critically ill patients is high, High gastric residuals is the most frequent GIG. These complications decreased nutrient intake and, if persistent, could expose the patients to undernutrition, Enteral feeding gastrointestinal intolerance seems to have an evolutive effect in prolonging the ICU stay and increasing patient mortality.