改善肠道营养耐受性和蛋白质摄入量可能对重症监护室患者有益
Ming Zhong1, Yuzhen Qiu1, Tingting Pan1
1Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Scientific reports
|December 7, 2023
概括
在上海重症监护室改善肠道营养 (EN) 是至关重要的. 到第7天达到EN耐受性可以保护患者,而低蛋白摄入量和高AGI等级是死亡的风险因素.
科学领域:
- 关键护理医学 关键护理医学
- 临床营养学 临床营养学
- 重症监护病房 (ICU) 管理管理
背景情况:
- 肠道营养 (EN) 对重症病患在重症监护室 (ICU) 的患者至关重要.
- 上海ICU目前的EN实践需要调查,以确定需要改进的领域.
- 优化EN输送可能会对患者的预后和结果产生积极影响.
研究的目的:
- 评估上海重症监护病房 (ICU) 肠道营养 (EN) 实践的现状.
- 确定影响EN耐受性的因素及其与临床结果的关联.
- 探索改善EN耐受性和蛋白质摄入量对患者生存的潜在益处.
主要方法:
- 一项前性研究收集了2019年上海重症监护室491名患者的EN使用临床数据.
- 数据包括患者人口统计,EN处方,耐受性 (定义为<20 kcal/kg/day) 和临床结果.
- 在启动EN后的1,3,7天进行了观察;逻辑回归分析了死亡率和EN耐受性的风险因素.
主要成果:
- 随着时间的推移,EN不耐受性的比例下降,从第1天的100%降至第14天的52.23%.
- 与28天死亡率增加相关的因素包括年龄较大,mNutric得分较高和第7天蛋白质摄入量<0.5g/kg/天.
- 在第7天达到EN耐受性,并在第3或第7天获得足够的蛋白质摄入量 (>0.5g/kg/day) 是预防28天死亡的保护因素. 第1天的AGI等级是EN耐受性差的重要风险因素.
结论:
- 目前,上海重症监护室的肠道营养耐受性很低,观察到显著的不耐受性.
- 在启动后7天达到EN耐受性是28天生存的关键保护因素.
- 提高EN耐受性和确保足够的蛋白质输送是提高ICU患者临床结果的潜在策略.
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