根据神经危急患者的治疗应用而改变蛋白质需求
Jungook Kim1, Youngbo Shim2, Yoon-Hee Choo3
1Department of Traumatology, Gachon University Gil Medical Center, Incheon, Korea.
Journal of Korean Neurosurgical Society
|November 20, 2023
概括
接受昏迷治疗和有针对性的温度管理 (TTM) 的重症患者需要比标准指南建议的蛋白质摄入量更高. 随着TTM和昏迷治疗的逐渐减少,蛋白质需求显著增加,突出了对个性化营养策略的需求.
科学领域:
- 关键护理医学 关键护理医学
- 营养科学 营养科学
- 神经学 神经学
背景情况:
- 重症患者的蛋白质需求至关重要,但可能会因特定治疗而改变.
- 昏迷治疗和有针对性的温度管理 (TTM) 显著影响大脑和全身新陈代谢.
- 没有先前的研究研究了在TTM和昏迷治疗期间或之后的蛋白质需求.
研究的目的:
- 确定接受昏迷治疗和TTM的重症患者的蛋白质需求.
- 分析在TTM和昏迷治疗应用的不同阶段蛋白质需求的变化.
主要方法:
- 对前性收集的ICU数据的回顾性分析 (2019年3月-2022年5月).
- 包括接受昏迷治疗和TTM的患者.
- 治疗分为两个阶段:应用/维护 (第一阶段) 和逐渐减少/停止 (第二阶段).
- 使用尿尿酸 (UUN) 方法评估蛋白质需求,以确定平衡和蛋白质需求的平衡±5.5.
主要成果:
- 平均蛋白质需求量为1.84±0.62g/kg/天,超过1.2g/kg/天的一般建议.
- 蛋白质需求在第2阶段 (逐渐减少) 显著增加至2.18±0.60g/kg/天 (p<0.001),从第1阶段的1.49±0.42g/kg/天增加到2.18±0.60g/kg/天 (p<0.001).
- 分析了107名患者的数据 (214个UUN值).
结论:
- 在TTM和昏迷治疗期间的平均蛋白质需求很高 (1.84±0.62g/kg/天),与现有指南的上限保持一致.
- 在这些治疗的逐渐减少阶段,蛋白质需求显著增加.
- 目前的指导方针应该扩展,考虑治疗类型和时间,而不仅仅是疾病严重程度,以获得最佳的营养支持.
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