重症老年人之早期腸道營養

Early Enteral Nutrition in Critically Ill Geriatric Patients

本研究目的是了解國內內科重症老年人的腸道營養攝食狀況，並探討腸道營養適當性對預後之影響。以回溯性研究調查2006 年7 月至2006 年11 月某醫學中心的內科加護病房，共有72 名年齡大於65歲的腸道灌食病人納入研究。以入加護病房48 小時實際攝取熱量達成營養師評估的熱量需求百分比分為未餵食、餵食不足及餵食適當三組，結果有82％病人在48 小時內餵食，熱量攝取達營養需求百分比在第二天達66.9±41.2％，第四天達到78.5±32.0％。加護病房平均熱量攝取達73％，造成餵食不足主要原因為檢查或手術佔33.3％。未餵食組在加護病房天數顯著高於其他兩組（15.0±8.7 vs. 9.6±5.5 vs. 9.3±7.8 天，P=0.042），在住院天數和死亡率無統計差異。本研究結論是內科加護病房的老年人不易達成熱量需求，但儘可能在病人入加護病房48 小時內給予腸道營養，有助減少加護病房天數。

The purpose of this study was to evaluate the early enteral nutrition and their outcomes among critically ill geriatric patients. We total enrolled 72 geriatric patients (older than 65 years) in our intensive care unit (ICU) ward. Trained dietitians assessed the actual intake in the first 48 hours after entering ICU. The patients were divided into three subgroups as fasting, underfeeding and adequate feeding based on the proportion of actual calories intake to estimate required calories. About 82% cases were fed in the first 48 hours after entering ICU. After 24 hours of entering ICU, the average calories intake was 66.9±41.2% of the estimated required calories, and was 78.5±32.0% after 96 hours hospitalization. The overall average calories intake was about 73% of the estimated required calories in ICU and the causes of underfeeding were waiting for examination or operation. The duration of staying in ICU was significantly longer for fasting group compared with other two groups (15.0±8.7 vs. 9.6±5.5 vs. 9.3±7.8, p=0.042). However, there was no significant difference for the duration of hospitalization and mortality rate among these three subgroups. In this study, we found that the calories intake among geriatric patients in ICU were hardly to reach their estimated required calories intake. Early enteral nutrition in first 48 hours after entering ICU may reduce the duration of ICU hospitalization.