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目的危重症患者早期常规营养支持的最佳方案仍不明确,设想肠外营养要优于肠内营养。方法对英国33个重症监护室新入院的成年患者进行随机对照研究。把患者随机分为肠外营养组或肠内营养组,营养支持在入院后36小时内开始,持续不超过5天。主要结局指标是30天的死亡率。结果共纳入患者2400例进入研究,2388例(99.5%)纳入最终的统计分析,其中1191例采用肠外营养,1197例采用肠内营养。营养支持第30天时,肠外营养组的累计死亡率是33.1%(393/1188),肠内营养组的累计死亡率是34.2%(409/1195),肠外营养相对于肠内营养的相对危险度是0.97(95%CI:0.86~1.08,P=0.57)。在减少低血糖发生率(3.7%vs.6.2%,P=0.006)和降低呕吐发生率(8.4%vs.16.2%,P<0.001)方面,肠外营养显著优于肠内营养。在治疗相关性感染性并发症(0.22 vs.0.21,P=0.72)、90天累计死亡率(37.3%vs.39.1%,P=0.40)方面,以及其他14项次要结局指标的发生率和不良反应发生率方面,肠外营养与肠内营养相比无显著差异。热量摄入方面两组无显著差异,大多数患者均未达到要求的能量摄入量。结论危重症患者早期肠外或肠内营养支持第30天累计死亡率没有统计学差异,但是肠外营养可以减少低血糖和呕吐的发生。
Objectives The optimal protocol for early routine nutritional support in critically ill patients remains unclear. Imagine that parenteral nutrition is superior to enteral nutrition. METHODS: Randomized controlled trials of newly admitted adult patients in 33 intensive care units in the United Kingdom were performed. Patients were randomly assigned to parenteral nutrition group or enteral nutrition group. Nutritional support started within 36 hours after admission and lasted no more than 5 days. The main outcome measure is the 30-day mortality rate. Results A total of 2,400 patients were enrolled in the study, and 2388 patients (99.5%) were included in the final statistical analysis, of which 1191 were enteral nutrition and 1197 enteral nutrition. Nutritional support At 30 days, the cumulative mortality for the parenteral nutrition group was 33.1% (393/1188), for the enteral nutrition group was 34.2% (409/1195), for parenteral nutrition relative to enteral nutrition The risk was 0.97 (95% CI: 0.86 to 1.08, P = 0.57). Parenteral nutrition was significantly better than enteral nutrition in reducing the incidence of hypoglycemia (3.7% vs. 6.2%, P = 0.006) and reducing the incidence of vomiting (8.4% vs.16.2%, P <0.001). In the treatment of associated infectious complications (0.22 vs.0.21, P = 0.72), 90-day cumulative mortality (37.3% vs.39.1%, P = 0.40), and the incidence of other 14 secondary outcome measures and There was no significant difference in the incidence of adverse reactions between parenteral nutrition and enteral nutrition. There was no significant difference in caloric intake between the two groups, with most of the patients failing to achieve the required energy intake. Conclusions The cumulative 30-day cumulative mortality of early parenteral or enteral nutrition in critically ill patients is not statistically different, but parenteral nutrition can reduce the incidence of hypoglycemia and vomiting.