随机,受控,多中心,开放,并行组研究 (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
概括
危急病患的早期肠道营养并没有降低死亡率或感染风险. 然而,与肠道营养相比,它增加了吐和腹等消化问题的风险.
科学领域:
- 危急护理医学
- 临床营养
- 胃肠病学
背景情况:
- 在严重危急疾病中早期营养支持的最佳途径仍在争论中.
- 早期营养对于重症监护室 (ICU) 患者的康复至关重要.
研究的目的:
- 为了比较早期第一线肠道营养与严重病情的成年人的肠道营养.
- 研究食路线对死亡率,感染和消化系统并发症的影响.
主要方法:
- 这是一项随机,受控,多中心的开放性研究 (NUTRIREA-2试验),涉及法国重症监护室的2410名成年人.
- 患者在输管后24小时内接受肠道营养 (EN) 或肠外营养 (PN),以达到正常热量目标.
- 主要终点是28天的死亡率,次要终点包括ICU获得的感染和消化系统并发症.
主要成果:
- 肠道 (37%) 和亲肠道 (35%) 组28天死亡率没有显著差异 (p=0. 33).
- 在ICU获得感染的累积发病率中没有显著差异 (14%对16%,p=0. 25).
- 肠道组出现吐 (34% vs 20%),腹 (36% vs 33%),肠道缺血 (2% vs < 1%) 和急性结肠伪阻塞 (1% vs < 1%) 的发生率显著增加.
结论:
- 危急病患的成年人早期的同热量肠道营养没有降低死亡率或二次感染.
- 与早期的肠道营养相比,早期的肠道营养与胃肠道并发症的风险增加有关.
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