临床时讯 ＞ 临床研究
结果：共有1192例入院患者，其中22.6%的患者（n=262，61%男性，平均年龄46.1岁）NPO或CLD≥3天（平均NPO 5.2天，CLD 1.04天）入选该研究。采用CLD饮食医嘱的原因较采用NPO饮食医嘱的原因不确定性更高（32.1%比15.0%，P<0.05）。MNT认为开具NPO饮食医嘱原因较开具CLD饮食医嘱原因更加合理（58.6%比25.6%，P<0.05）。与MNT推荐的一致性仅有40.0%。
JPEN J Parenter Enteral Nutr. 2011 May;35(3):337-42.
Physician-delivered malnutrition: why do patients receive nothing by mouth or a clear liquid diet in a university hospital setting?
Franklin GA, McClave SA, Hurt RT, Lowen CC, Stout AE, Stogner LL, Priest NL, Haffner ME, Deibel KR, Bose DL, Blandford BS, Hermann T, Anderson ME.
Departments of Surgery and Medicine, University of Louisville, Louisville, Kentucky 40202, USA.
BACKGROUND: Traditional practices of placing patients nil per os (NPO) or on clear liquid diet (CLD) deter delivery of optimal nutrition care and are not always supported by sound physiologic principles.
OBJECTIVE: This perspective survey evaluated the incidence of this practice, the reasons for such orders, and the response to intervention by the Multidisciplinary Nutrition Team (MNT).
METHODS: All patients admitted to University of Louisville Hospital were monitored by MNT dietitians and were candidates for the study if they were placed NPO upon CLD for ≥ 3 days. The MNT determined appropriateness of diet orders.
RESULTS: Out of 1192 admissions, 22.6% of the patients (n = 262, 61% male, mean age 46.1 years) were found to be NPO or on CLD for ≥ 3 days (mean 5.2 days NPO, 1.04 days CLD), and were entered in the study. Uncertainty regarding the reason for the specific diet order occurred more often when patients were placed on CLD than when made NPO (32.1% vs. 15.0% of cases, respectively, P < 0.05). NPO diet orders were more often deemed appropriate by the MNT than were orders for CLD (58.6% vs. 25.6%, respectively, P < 0.05). Compliance with MNT recommendations was low at 40.0%.
CONCLUSIONS: Despite an active MNT, 22% of patients were made NPO or placed on CLD for a prolonged period of time. More than a third of diet orders for NPO and two thirds of orders for CLD were inappropriate and poorly justified. Improving the adequacy of nutrition therapy is hampered by noncompliance with MNT recommendations.