慢性重症患者的高或低蛋白摄入量:系统审查和元分析
Sílvia Castro1, A Tomé2, C Granja3
1Unidade Local de Saúde do Algarve, Faro, Portugal; Algarve Biomedical Center Research Institute, Faro, Portugal; Faculdade de Medicina e Ciências Biomédicas, Universidade do Algarve, Faro, Portugal.
Clinical nutrition ESPEN
|December 11, 2024
概括
在慢性严重疾病 (CCI) 中,较高的蛋白质摄入量 (>1.3 g/kg/d) 可能会降低早期死亡率,但不会影响其他结果. 需要更多的研究来证实对重症患者的益处.
科学领域:
- 关键护理医学 关键护理医学
- 营养科学 营养科学
- 临床营养学 临床营养学
背景情况:
- 慢性严重疾病 (CCI) 是通过在ICU的第一周后持续的器官功能障碍来定义的.
- 获得的肌肉衰弱,肌肉质量损失和肌肉病变在CCI中很常见.
- 对CCI患者的最佳蛋白质摄入量仍然不确定,营养指南缺乏共识.
研究的目的:
- 系统地审查高蛋白摄入量与低蛋白摄入量对CCI患者临床结果的影响.
- 为了评估蛋白质补充剂在危急疾病的第一周之后的疗效.
主要方法:
- 在PUBMED,CENTRAL和WEB OF SCIENCE进行系统搜索,寻找重症患者 (>7天ICU停留) 成人蛋白质摄入量研究.
- 包括的研究比较了蛋白质摄入量>1.3g/kg/d与较低摄入量,在第一个ICU周后进行干预.
- 评估结果包括死亡率,ICU/住院时间,机械通风持续时间,感染,肌肉质量和身体功能.
主要成果:
- 四项研究 (N=1730) 表明,较高的蛋白质摄入量与早期死亡率的降低有关 (HR 0.42,P<0.001).
- 没有观察到对晚期死亡率,机械通风的持续时间,ICU/住院时间,肌肉质量或ICU获得感染的显著影响.
- 一项研究报告说,3个月和6个月的身体功能改善,蛋白质摄入量更高.
结论:
- 在CCI中增加蛋白质摄入量到>1.3g/kg/d可能会改善早期死亡率,但不能改善晚期死亡率或其他临床结果.
- 结论受到研究数量少和结果异质性的限制.
- 需要进一步的研究,以确定在慢性严重疾病中摄入较高蛋白质的益处.
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