早期高蛋白摄入量对重症患者的影响:一项随机对照试验
Yifei Wang1, Yanyang Ye1, Lusha Xuan1
1Intensive Care Unit, Zhuji Traditional Chinese Medical Hospital, Zhuji, 311800, Zhejiang, China.
Nutrition & metabolism
|June 29, 2024
概括
在重症患者中,较高的早期蛋白质摄入量 (1.5 g/kg/d) 改善了营养状况和预后,降低了死亡率和ICU停留时间. 这种方法似乎是安全的,有利于恢复.
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
- 重症监护病房管理部门的管理.
背景情况:
- 关于高蛋白摄入量对早期重症患者的影响存在相互矛盾的证据.
- 评估较高的早期蛋白质摄入量对预后的影响对于优化患者护理至关重要.
研究的目的:
- 评估早期增加蛋白质补充剂对重症患者预后的影响.
- 为了确定较高的蛋白质摄入量是否会改善死亡率和停留时间等结果.
主要方法:
- 一项随机对照试验,涉及173名危急病患者,需要至少7天的重症监护病房/急诊ICU (ICU/EICU).
- 患者在开始肠道营养 (EN) 的1-3天内接受0.8g/kg/d (低组,n=87) 或1.5g/kg/d (高组,n=86) 的蛋白质,两组在第4天过渡到1.5g/kg/d.
- 在整个ICU/EICU逗留期间,关键参数包括血清前白蛋白 (PA),血尿素/肌素比率和直骨肌的大小都被监测.
主要成果:
- 在低蛋白和高蛋白组之间没有观察到显著的基线差异.
- 与低蛋白质组相比,高蛋白质组的28天死亡率明显较低 (HR=2.462).
- 接受较高蛋白质摄入量的患者经历了更短的机械通风持续时间,减少了ICU停留时间,改善了血清PA水平,减少了肌肉缩.
结论:
- 增加早期的蛋白质摄入量到1.5g/kg/d对重症患者来说是安全的.
- 较高的早期蛋白质摄入量可以提高营养状况并改善患者的预后.
- 这一策略可能有利于降低危急病患者群体的死亡率和ICU停留时间.
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