重症肿瘤伴血小板减少患者放置喂养管相关出血

Nutr Clin Pract. 2016 Feb;31(1):111-5.

Bleeding Associated With Feeding Tube Placement in Critically Ill Oncology Patients With Thrombocytopenia.

Patel RP, Canada TW, Nates JL.

University of Texas MD Anderson Cancer Center, Houston, Texas.

BACKGROUND: Existing trials have not evaluated the feasibility of oral or nasal feeding tube (FT) placement in the critically ill thrombocytopenic oncology population. Thrombocytopenia (TCP) may be considered a contraindication to FT placement due to the potential risk of bleeding complications.

METHODS: Medical intensive care unit (ICU) adult oncology patients with attempted nasal or oral FT placement were evaluated in a 52-bed ICU at a comprehensive cancer center. End points were compared between patients with and without TCP (platelet count <150,000/μL). Primary outcomes of overt and clinically important bleeding (gastrointestinal and point of entry) were evaluated within 72 hours of FT placement.

RESULTS: Fifty-nine patients were enrolled (TCP, n = 42; no TCP, n = 17; baseline platelet count, 41 ± 48 vs 249 ± 85 [× 10(3)/μL], P < .001). Patients with TCP were more likely to have a hematologic malignancy and lower baseline hemoglobin and platelet count (P < .01). More patients with TCP received blood products 24 hours prior to FT placement (86% vs 12%, P < .01). There was no difference in overt (7.1% vs 0%, P = .55) or clinically important (2.4% vs 5.9%, P = .5) bleeding complications within 72 hours of attempted FT placement among patients with TCP versus those without.

CONCLUSIONS: Critically ill oncology patients with TCP do not appear to be at a higher risk for bleeding complications after FT placement compared with those without TCP, which may be related to blood product transfusion within 24 hours prior to FT placement.

KEYWORDS: critical care; critical illness; enteral nutrition; hemorrhage; oncology; thrombocytopenia

PMID: 26296984

DOI: 10.1177/0884533615598964