Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial
Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial
复制标题
DOI：
10.1016/s0140-6736(05)17983-5
复制
发表时间：
2005-02-01
期刊：
影响因子：
168.9
通讯作者：
Warlow, C
中科院分区：
文献类型：
--
作者：
Clarke, J;Cranswick, G;Warlow, C
背景脑卒中住院患者营养不良是常见的。我们的目的是建立是否时间和路线的肠内管喂养中风后影响患者的结果在6 months.Methods的食物试验包括三个务实的多中心随机对照试验，其中两个包括吞咽困难的中风患者。在一项试验中，在入院7天内入选的患者被随机分配到早期肠内管饲或不管饲超过7天（早期与避免）。在另一组中，患者被分配经皮内镜胃造口术（PEG）或鼻饲。主要结局为6个月时死亡或结局不良。结果1996年11月1日至2003年7月31日，859例患者在15个国家的83家医院参加了早期与避免试验。早期管饲与死亡风险的绝对降低相关5。8%（95% CI-0.八到十二岁。5，p=0.09）和死亡或不良结局减少1。2%（-4.2至6.6，p=0.7）。在PEG与鼻胃管试验中，11个国家的47家医院招募了321名患者。PEG喂养与死亡风险的绝对增加相关1。0%（-10。0到11。9，p=0。9)死亡或预后不良的风险增加7.8%（0，0到15岁。5，p=0。05).早期管饲可能降低病死率，但代价是增加预后不良的存活率。我们的数据不支持吞咽困难的卒中患者早期开始PEG喂养的政策。
Background Undernutrition is common inpatients admitted with stroke. We aimed to establish whether the timing and route of enteral tube feeding after stroke affected patients' outcomes at 6 months.Methods The FOOD trials consist of three pragmatic multicentre randomised controlled trials, two of which included dysphagic stroke patients. In one trial, patients enrolled within 7 days of admission were randomly allocated to early enteral tube feeding or no tube feeding for more than 7 days (early versus avoid). In the other, patients were allocated percutaneous endoscopic gastrostomy (PEG) or nasogastric feeding. The primary outcome was death or poor outcome at 6 months. Analysis was by intention to treat.Findings Between Nov 1, 1996, and July 31, 2003, 859 patients were enrolled by 83 hospitals in 15 countries into the early versus avoid trial. Early tube feeding was associated with an absolute reduction in risk of death of 5 . 8% (95% CI -0 . 8 to 12 . 5, p=0.09) and a reduction in death or poor outcome of 1 . 2% (-4.2 to 6.6, p=0.7). In the PEG versus nasogastric tube trial, 321 patients were enrolled by 47 hospitals in 11 countries. PEG feeding was associated with an absolute increase in risk of death of 1 . 0% (-10 . 0 to 11 . 9, p=0 . 9) and an increased risk of death or poor outcome of 7.8% (0 . 0 to 15 . 5, p=0 . 05).Interpretation Early tube feeding might reduce case fatality, but at the expense of increasing the proportion surviving with poor outcome. Our data do not support a policy of early initiation of PEG feeding in dysphagic stroke patients.