空腸造口對重症病患的營養狀況及臨床結果的影響

住院病患常發生營養不足的現象，尤其是經過腸胃道手術的病患。研究顯示經由適當的營養支持路徑，不僅使病患得到所需的營養，改善營養狀況，也將減少住院天數、併發症的發生及壓力性潰瘍等。本研究目的是評估經由空腸造口是否成為經過重大上消化道手術重症病患的合適營養支持路徑。受試者為被診斷為胃潰瘍或十二指腸潰瘍合併穿孔的成人病患（> 18歲），且住加護病房至少5天以上。根據病患是否接受空腸造口營養支持，將病患分為二組，空腸造口組（n = 13）及無空腸造口組（n = 19）。從符合條件的病患病歷回溯紀錄病患的基本資料、營養狀況、血液生化值、開始腸道營養時間、接受腸道營養後腸胃道併發症出現次數及是否因此暫停腸道營養的原因紀錄。結果顯示，術前營養狀況以主觀整體性營養評估（SGA）評估，分A、B、C三級，C級表示嚴重營養不良。具有C級程度營養不良人數分別在空腸造口組佔9.1%（1人）及無空腸造口組佔28.6%（4人）。而A級之人數在空腸造口組佔36.4%（4人）、無空腸造口組為35.7%（5人）。空腸造口組經由腸道營養支持後，開始腸道營養支持時間與無空腸造口組並無差異（9.49 ± 2.56天vs. 11.90 ± 3.02天），但發生腸胃併發症的次數卻是空腸造口組較多，其中以腹脹及腹痛為主，各佔61.5%及69.2%。暫停腸道營養的原因則以無空腸造口組的上消化道出血為最多，佔44.4%。總能量及營養素攝取量與疾病嚴重度（APACHE II score）、使用呼吸器天數、住ICU及住院天數的相關性，皆未呈現顯著相關性。血紅素差值（出ICU-入ICU）與疾病嚴重度呈負相關（r ＝ -0.492, p ＝ 0.004）。術前白血球數目與疾病嚴重度也呈負相關（r ＝ -0.428, p ＝ 0.014）。本研究結果並未支持經由空腸造口路徑對重大消化道手術病患較其他營養支持方式（如靜脈營養）可改善營養狀況及預後結果。

關鍵字

胃潰瘍；十二指腸潰瘍；穿孔；空腸造口；腸道營養；重症病人

並列摘要

The prevalence of malnutrition is a common problem in hospitalized patients, especially in critically ill patients who are being received gastrointestinal surgery. Studies have shown that appropriate nutritional support route appears to improve nutritional status, reducing length of hospitalization, complications and stress ulcer. The purpose of this study was to assess whether jejunostomy is an appropriate feeding route for major upper gastrointestinal surgery critically ill patients. Patients were diagnosed as either gastric or duodenum ulcer combined with perforation (＞18 y), and stayed at least for 5 days in the intensive care unit. Patients were divided into either jejunostomy group (n = 13) or non-jejunostomy group (n = 19) based on their nutritional support route. Patients’ basic characteristics, nutritional status, hematological values, time for initiating the enteral feeding, gastrointestinal complications and reasons for cessation of enteral nutrition from their medical charts were retrospectively recorded. No significant differences were found in the time for initiating the enteral nutrition between two groups (9.49 ± 2.56 d vs. 11.90 ± 3.02 d). However, there were more gastrointestinal complications in the jejunostomy group including of abdominal distention (61.5%) and abdominal pain (69.2%) when compared to the non-jejunostomy group. The major reason for the cessation of enteral nutrition in the non-jejunostomy group was upper gastrointestinal bleeding (44.4%). The total energy conservation, dietary intake, APACHEⅡ Score-assessed disease severity, ventilator dependent days, ICU days, and hospital days, the correlation was insignificantly different. The hematological differences (before and after ICU days) and disease severity were negatively correlated （r ＝ -0.492, p ＝ 0.004）, and so were the preoperative WBC number and disease severity （r ＝ -0.428, p ＝ 0.014）. Patients with gastric or duodenum ulcer combined with perforation did not show good improvement of nutritional status and clinical outcomes after receiving nutritional support route via jejunostomy.

並列關鍵字

gastric ulcer ； duodenum ulcer ； perforation ； jejunostomy ； enteral nutrition ； critically ill patients

參考文獻

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國際替代計量

空腸造口對重症病患的營養狀況及臨床結果的影響

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