ショックを受けた成人における腸内対腸内早期栄養:ランダム化,制御,多センター,オープン,並列群試験 (NUTRIREA-2)
Jean Reignier1, Julie Boisramé-Helms2, Laurent Brisard3
1Médecine Intensive Réanimation, CHU de Nantes, Nantes, France; Université de Nantes, Nantes, France.
Lancet (London, England)
|November 13, 2017
まとめ
ショックを受けた重症の成人の早期腸内栄養は死亡率や感染リスクを低下させなかった. しかし 腸内栄養と比べると 嘔吐や下痢などの 消化障害のリスクが増加しました
科学分野:
- クリティカル ケア 医療
- 臨床栄養について
- 胃腸内科
背景:
- 重篤な病気の早期栄養支援の最適な経路は まだ議論されている.
- 集中治療室 (ICU) の患者の回復には,早期の栄養が不可欠です.
研究 の 目的:
- 重症でショックを受けた成人の 腸内栄養と親腸内栄養の 結果を比較する
- 死亡率,感染症,消化器系の合併症に対する栄養経路の影響を調査する.
主な方法:
- フランスICUの2410人の成人を対象としたランダム化,制御,多センター,オープンラベル試験 (NUTRIREA-2試験).
- 患者さんは24時間以内に腸内栄養 (EN) または親腸内栄養 (PN) を受け,ノルモカロリー目標を達成しました.
- 主要エンドポイントは28日間の死亡率で,次要エンドポイントはICUで発症した感染症と消化器系の合併症でした.
主要な成果:
- 腸内 (37%) と親腸内 (35%) 群の28日間の死亡率は有意な差異はなかった (p=0. 33).
- 集団間のICU感染の累積的な発生率 (14%対16%,p=0. 25%) は有意ではない.
- 嘔吐 (34% vs 20%),下痢 (36% vs 33%),腸内血症 (2% vs < 1%),および急性大腸閉塞 (1% vs < 1%) が著しく高かった.
結論:
- ショック状態の重篤な成人における早期の同カロリー腸内栄養は,死亡率や二次感染を減少させない.
- 早期の腸内栄養は,早期の親腸内栄養と比較して,胃腸合併症のリスクが高くなります.
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