上消化道出血的重症病人執行儘早進食策略的影響

The clinical impact of early enteral feeding in critically ill patients with upper gastrointestinal bleeding

趙苔君(Tai-Chun Chao) ； 賴志政(Chi-Cheng Lai) ； 鄭俊達(Chun-Ta Cheng) ； 劉美媛(Mei-Yuan Liu) ； 黃秋華(Chin-Hua Huanag)

《臺灣營養學會雜誌》 41卷2期 (2016/06) Pp. 67-74

https://doi.org/10.6691/NSJ.201606_41(2).0003

摘要

對於重症病人，上消化道出血（upper gastrointestinal bleeding, UGIB）常使腸道進食計畫中斷或暫停，因此恐將加重病況，以致延緩腸道進食時間。本研究以病歷回溯方式，在100年7月到102年6月共收集278位上消化道出血之內科重症病人，探討實施儘早進食策略後對腸胃道 功能的影響。該策略是由護理師、醫師、營養師共同擬定：依內視鏡結果決定病人禁食天數，監測與記錄病人禁食原因，討論病人立即進食的可能性，以及逐案討論禁食72小時以上的案例。結果顯示，儘早腸道餵食組（early enteral feeding, EEF）有52.2%患者在72小時內達到75%目標熱量，而未實施儘早腸道餵食組（None early enteral feeding, NEEF）只有23.6%患者達到75%目標熱量（p ＜ 0.001），同時縮短等待進食的時間由52.8 ± 19.2小時（NEEF組）縮短至45.6 ± 21.6小時（EEF組）（p ＜ 0.05）。而儘早腸道餵食（EEF組）也不會提高如嘔吐及腹瀉等腸胃道併發症及提高死亡的比例。此篇結果顯示，上消化道出血病人應儘量避免禁食過久，可依內視鏡結果判斷以決定營養策略，如狀況允許則應實施儘早進食策略。

關鍵字

上消化道出血 ； 儘早腸道餵食 ； 重症病人 ； 腸道餵食 ； 食道靜脈曲張 ； 內視鏡

並列摘要

In critically ill patients with upper gastrointestinal bleeding (UGIB), enteral feeding planning is usually intermittent or is terminated because of feeding delays in a worsening condition. The purpose of the study was to try to realize the clinical effects of early enteral feeding (EEF). The clinical data were retrospectively collected between July 2011 and June 2013, and data on a total of 278 critically ill patients with UGIB were collected. Team members included physicians, nurses, and dietitians, and they produced the following strategies: the days of nil per os (NPO) of patients based on endoscopic findings; the possibilities of food intake by patients; the monitoring and recording of the cause of NPO; and a discussion of cases with greater than 72 hours of NPO. The results show that 52.2% of patients in the early enteral feeding (EEF) group can reached 75% of the target calories within 72 h, while only 23.6% of patients in the non-early enteral feeding (NEEF) group reach the 75% of the target calories (p ＜ 0.001). However, EEF did not significantly raise the gastrointestinal complications, such as vomiting and diarrhea, or cause death. In conclusion, deciding the nutritional strategies of UGIB patients depends on the endoscopic record and shortening the NPO status. It would be better to feed UGIB patients as soon as possible if necessary.

並列關鍵字

upper gastrointestinal bleeding ； early feeding ； critically III patients ； enteral feeding ； endoscopic