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Crit Care:危重症患者的营养支持治疗现状

2017-08-30 MedSci MedSci原创

重症监护病房(ICU)危重病人的营养不良与死亡风险显着升高有关。适当的营养治疗对患者预后至关重要。近期,一项发表在杂志Crit Care上的研究描述了当前拉丁美洲ICU中的临床营养实践,并评估目前的做法是否符合接受营养治疗的危重病人的热量和蛋白质需求。研究者们在拉丁美洲的八个国家(阿根廷、巴西、智利、哥伦比亚、厄瓜多尔、墨西哥、巴拿马和秘鲁)进行了横断面回顾性的观察性研究。符合入选标准的患者为IC

重症监护病房(ICU)危重病人的营养不良与死亡风险显着升高有关。适当的营养治疗对患者预后至关重要。


近期,一项发表在杂志Crit Care上的研究描述了当前拉丁美洲ICU中的临床营养实践,并评估目前的做法是否符合接受营养治疗的危重病人的热量和蛋白质需求。

研究者们在拉丁美洲的八个国家(阿根廷、巴西、智利、哥伦比亚、厄瓜多尔、墨西哥、巴拿马和秘鲁)进行了横断面回顾性的观察性研究。符合入选标准的患者为ICU住院的危重病人,并在筛选日和前一天(第-1天)接受肠内营养(EN)和/或肠外营养(PN)。研究者们记录了第-1天的热量和蛋白质平衡,营养状况和规定的营养治疗。随后使用多变量逻辑回归分析,以确定达到每日热量和蛋白质目标的独立预测因子。

最终,共分析来自116家医院的1053名患者。营养状况评估显示,根据主观综合评估,74.1%的患者可能有中度或重度营养不良。规定的营养治疗包括单独的EN(79.9%),单独的PN(9.4%)和EN + PN(10.7%)。在第-1天,59.7%患者的热量摄入量达到了日间目标的90%;40.3%的患者存在热量缺乏,平均(±SD)每日热量不足为-688.8±455.2千卡。多变量Logistic回归分析显示,与EN单独相比,EN + PN的联合给药可以显著增加每日热量和蛋白质目标比例达到>90%的比例(优势比,1.56; 95%置信区间,1.02- 2.39;p = 0.038)。

此项研究表明:在拉丁美洲的ICU中,普遍存在营养不良,在接受营养支持治疗的危重症患者总约40%的患者未能接受合格的营养治疗。PN的补充与改善的能量和蛋白质递送有关;然而,PN的使用率较低。综上所述,在不能从单独EN中获得足够营养的危重病人中,应更有效地利用PN的治疗方法。

原始出处:
Vallejo KP, Martínez CM, et al. Current clinical nutrition practices in critically ill patients in Latin America: a multinational observational study. Crit Care. 2017 Aug 25;21(1):227. doi: 10.1186/s13054-017-1805-z.

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    2017-11-06 qblt
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