呼吸器相关的隔膜功能障碍的可修改风险因素:一个多中心观察性研究
Hong Pu1, Gordon S Doig2, Yu Lv3
1Department of Critical Care Medicine, West China Medical School, West China Hospital, Sichuan University, Chengdu, PR China.
BMC pulmonary medicine
|September 12, 2023
概括
在ICU的早期氨基酸摄入可以预防腹膜功能障碍,并降低重症患者的死亡率. 这种可修改的因素对于改善结果和减少呼吸机相关的肺炎和输出失败至关重要.
科学领域:
- 关键护理医学 关键护理医学
- 肺部病理学 肺部病理学
- 营养科学 营养科学
背景情况:
- 隔膜功能障碍是严重病患者需要机械通风的已知并发症,导致患者的治疗结果较差.
- 目前对隔膜功能障碍的预防策略的理解仍然有限,强调需要确定可修改的风险因素.
研究的目的:
- 为了调查潜在的可修改的风险因素,与腹膜功能障碍相关的严重疾病的成年人.
- 估计改变被识别的可修改的隔膜功能障碍风险因素的潜在好处.
主要方法:
- 一项前性,多中心的观察性研究,涉及严重疾病的成年人,需要侵入性机械通风至少48小时.
- 隔膜功能每天使用超声波进行评估,功能障碍定义为厚度分数低于20%.
- 采用多变量分析和因果路径建模来确定独立的风险因素及其影响.
主要成果:
- 隔膜功能障碍发生在40.5%的受试患者中,与呼吸机相关的肺炎,输出管失败和长时间的通风/住院风险增加有关.
- 腹膜功能障碍患者在出院前的死亡率也更高.
- 对隔膜功能障碍的显著独立风险因素被确定为SOFA评分和在ICU住院的前24小时内早期的氨基酸摄入量.
结论:
- 在ICU入院的最初24小时内,早期的氨基酸摄入量是腹膜功能障碍的关键,可修改的风险因素.
- 充足的氨基酸摄入量可能在减少隔膜功能障碍和整体死亡率方面具有直接的因果作用.
- 建议进行进一步的研究,以探索早期氨基酸补充剂在预防腹膜功能障碍和改善患者存活率方面的治疗潜力.
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