Effect of acidified enteral feedings on gastric colonization in the critically ill patient
Effect of acidified enteral feedings on gastric colonization in the critically ill patient
复制标题
酸化肠内喂养对危重病人胃定植的影响
DOI：
10.1097/00003246-199210000-00005
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发表时间：
1992
影响因子：
8.8
通讯作者：
L. Mandell
中科院分区：
文献类型：
--
作者：
D. Heyland;Christine Bradley;L. Mandell
目的评价酸化肠内营养配方(饲料)对危重病人胃定植和pH的影响。设计三组随机双盲试验：a)定期喂入胃；b)定期喂入十二指肠；c)酸化喂入胃。在开始喂养后的平均5天内，每天取鼻胃抽吸物测定胃的pH值和微生物。将ICU安置在一家三级护理医院。31名在ICU第四天前接受肠内喂养的患者被随机分为两组。7名患者因不耐受、意外拔管或对口服补充剂耐受而停止喂养。一名患者接受了错误的喂养，并被排除在研究之外。共有23名患者完成了这项研究。多为外伤性(n=15)或神经外科(n=6)患者。年龄15~71岁，平均40岁。干预：以pH为6.5的肠内配方奶粉作为对照饲料。在对照组饲料中加入盐酸，使pH滴定至3.5，并给试验组喂食该酸化肠溶配方。所有患者均通过8-Fr喂养管进行持续肠内喂养。主要结果接受酸化喂养的8名患者中有7名在接受喂养时无菌(没有微生物生长)，而接受常规喂养的15名患者中有5名(p=0.027)。对于那些最初定居的患者，接受酸化喂养的四名患者中有四名立即变得无菌并保持无菌状态。在接受常规喂养的10名患者中，只有2名保持无菌状态(p=.021)。酸化组的胃平均pH值为3.2，与定期胃饲组(pH=4.7)和定期十二指肠饲养组(pH=3.8)相比(p<；.01)。没有任何患者有胃肠道出血的证据。结论酸化肠内营养能有效地消除和预防危重病人胃内定植。需要进一步的研究来评估其对医院感染率的影响。
ObjectiveTo evaluate the effect of acidified enteral nutritional formulas (feedings) on gastric colonization and pH in critically ill patients. DesignRandomized, double-blind trial of three groups: a) regular feedings into the stomach; b) regular feedings into the duodenum; and c) acidified feedings into the stomach. Nasogastric aspirates for gastric pH and microbiological determinations were obtained daily for a mean of 5 days after feeding began. SettingICU at a tertiary care hospital. PatientsThirty-one patients indicated to receive enteral feedings before day 4 in the ICU were randomized. Seven patients had their feedings discontinued because of intolerance, accidental extubation, or tolerance of oral supplementation. One patient received the wrong feedings and was dropped from the study. A total of 23 patients finished the study. They were mostly trauma (n = 15) or neurosurgical (n = 6) patients. The average age was 40 yrs (range 15 to 71). InterventionsAn enteral formula with a pH of 6.5 was used as the control feeding. Hydrochloric acid was added to the control feeding to titrate the pH to 3.5 and this acidified enteral formula was given to the experimental group. All patients received continuous enteral feedings via an 8-Fr feeding tube. Main ResultsSeven of eight patients receiving the acidified feedings were sterile (no microbial growth) on receiving feedings compared with five of 15 of those patients receiving regular feedings (p = .027). For those patients initially colonized, four of four patients receiving acidified feedings immediately became sterile and remained so. Only two of ten patients receiving regular feedings remained sterile (p = .021). The mean gastric pH of the acidified group was 3.2 compared with the group receiving regular feedings into the stomach (pH = 4.7) and the group receiving regular feedings into the duodenum (pH = 3.8) (p < .01). There was no evidence of gastrointestinal bleeding in any patient. ConclusionsAcidified enteral feedings are effective in eliminating and preventing gastric colonization in critically ill patients. Further investigation is needed to assess its effect on nosocomial infection rates.