在重症创伤患者的营养支持
Renaldo Williams1, Daniel Dante Yeh1
1Department of Surgery, Denver Health Medical Center, University of Colorado, Ernest E. Moore Shock Trauma Center, MC0206, 777 Bannock Street, Denver, CO 80204-4507, USA.
The Surgical clinics of North America
|March 7, 2024
概括
在受伤后24-48小时内提供早期的肠道营养对于重症患者至关重要. 有针对性的卡路里和蛋白质摄入量,以及腹腔营养,确保在严重疾病期间安全有效的营养支持.
科学领域:
- 关键护理医学 关键护理医学
- 营养支持 营养支持
- 临床营养学 临床营养学
背景情况:
- 对于重症患者来说,早期的营养干预至关重要.
- 确定从积极营养中获益最多的患者是关键.
- 营养的最佳时间和提供影响患者的结果.
研究的目的:
- 为启动和推进肠道营养制定基于证据的指导方针.
- 讨论营养风险评估在重症监护中的作用.
- 审查亲肠道营养和外科手术期间食的安全性和有效性.
主要方法:
- 对临界疾病中营养支持的当前证据的文献综述.
- 对启动食用肠道养的指导方针的分析.
- 在重症病的第一周评估蛋白质和卡路里目标.
- 对亲肠道营养和术后养的安全数据的评估.
主要成果:
- 肠道营养应在受伤后24-48小时内以热带速度开始.
- 血液动力学稳定是达到目标养速度的先决条件.
- 修改后的重症营养风险得分有助于识别高效益患者.
- 患者在第一周应获得估计卡路里的70-80%,蛋白质目标为1.5-2g/kg.
- 腹腔营养是一种安全的替代品或补充剂.
- 在选定的患者群体中,术后食是安全的.
结论:
- 早期和适当的肠道营养是重症监护管理的基石.
- 营养风险分层提高了养策略的个性化.
- 肠道和肠外营养都可以安全地实施,以满足患者的需求.
- 积极的营养治疗,当由风险评估和血液动力学稳定性为指导时,是有益的.
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