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Mixed Fibers Diet in Surgical ICU Septic Patients

外科加護病房敗血症者之混合纖維飲食

摘要


外科重症病患經常會發生腹瀉現象,特別是敗血症患者,而含纖配方已被報告可改善腹瀉症狀。大部分的報告僅使用可溶性纖維或是不可溶性纖維兩者之一,而混合纖維飲食的效果尚不清楚。本研究是比較混合纖維飲食及不含纖維飲食,兩者在接受廣效性抗生素的外科敗血症患者的腹瀉分數。我們在一個一般外科加護病房進行一項前瞻性雙盲隨機對照研究。接受廣效性抗生素及對腸道營養無禁忌症的病患被隨機分派至含纖飲食與不含纖飲食組進行達14天的研究。每天記錄營養給予及腹瀉分數。以及進行治療意圖分析。一共有34位病患被納入研究,其中17位為含纖飲食組,另外17位為不含纖飲食組。這兩組病患的人口學分布、疾病嚴重度、營養狀況、敗血症的導因以及每日的總攝食量是相似的。不含纖飲食組中,腹瀉分數≥12分的病患比例高於含纖飲食組,但是兩者的差異未達統計上顯著。含纖飲食組有較低的平均腹瀉分數,以及較低的來自廣義估計方程式模式重複測量所得的總腹瀉分數(係數為-3.03,95%CI:-5.03至-0.92,p=0.005)。總體而言,混合纖維飲食配方可以降低那些接受廣效性抗生素的外科術後嚴重敗血症病患的腹瀉程度。

並列摘要


Diarrhea commonly occurs in surgical critically ill patients, especially septic patients and fiber formulas have been reported to improve diarrhea. Most reports have used soluble or insoluble fiber exclusively, while the effects of a mixed fiber diet remain unclear. This study compares diarrhea scores between mixed-fiber and non-fiber diets in surgical septic patients receiving broad spectrum antibiotics. We conducted a prospective randomized control double blind study in a general surgical ICU. Patients who received broad spectrum antibiotics and no contraindication to enteral feeding were randomly allocated to a fiber or non-fiber diet for up to 14 days. Nutritional delivery and diarrhea scores were recorded daily. Intention to treat analysis was performed. Thirty-four patients were enrolled in the study, 17 in the fiber group and 17 in non-fiber group. These two patients groups were similar in demographics, disease severity, nutritional status, cause of sepsis and total feeding per day. The proportion of patients with diarrhea score ≥12 was higher in the non-fiber group than in the fiber group, but the difference was not statistically significant [8/17 (47.06%) vs. 4/17(23.53%); p=0.15]. However, the fiber group had a lower mean diarrhea score (fiber vs. non-fiber = 3.6 ± 2.3 vs. 6.3 ± 3.6; p=0.005), as well as a lower global diarrhea score from the generalized estimation equation model for repeated measurement [Coefficient -3.03 (95%CI= -5.03 to -0.92); p=0.005]. In summary, a mixed fiber diet formula can reduce the diarrhea score in surgical critically ill septic patients who received broad spectrum antibiotics.

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