早期的酸盐变化作为不准备人工养的潜在指标:EPaNIC RCT的二次分析
C Lauwers1, L Langouche1, P J Wouters1
1Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, 3000, Leuven, Belgium.
Critical care (London, England)
|January 28, 2025
概括
相对低酸盐血症 (RHP),酸盐水平的显著下降,识别了早期亲肠道营养 (PN) 损害的重症患者. 早期的PN恶化了RHP患者的结果,强调RHP是ICU定制营养策略的潜在指标.
科学领域:
- 关键护理医学 关键护理医学
- 营养支持营养支持
- 临床化学 临床化学
背景情况:
- 早期亲肠道营养 (PN) 在ICU的长期依赖与EPANIC试验中的延迟PN相比.
- 在ICU患者中,可通过暂时限制宏营养素来管理反食低血症 (酸盐下降>0.16 mmol/L至<0.65 mmol/L).
- 这项研究调查了早期的动态酸盐变化,而不仅仅是绝对水平,预测早期PN的危害.
研究的目的:
- 为了确定绝对低度血症 (AHP),相对低度血症 (RHP) 或联合低度血症 (CHP) 与早期PN对患者结果的影响是否相互作用.
- 评估RHP是否能够识别受到早期PN负面影响的重症患者.
主要方法:
- 涉及3520名患者的EPaNIC随机对照试验 (RCT) 的二次分析.
- 定义的AHP (<0.65 mmol/L在第二天),RHP (>0.16 mmol/L在前2天下降) 和CHP.
- 检查了低度血症类型和早期PN策略之间的相互作用,并根据风险因素进行调整.
主要成果:
- RHP发生在23.7%的患者中,并且与营养策略有显著的相互作用 (p=0.01).
- 在RHP患者中,早期PN与较早的ICU活着出院的可能性较低相关 (aHR为0.75).
- 早期PN没有与非RHP患者的结果显著相关 (aHR为0.93);根据基线特征,RHP的预测很差.
结论:
- 发展的RHP可以识别ICU患者受到早期PN管理的伤害.
- RHP可以作为一个潜在的指标,用于个性化的营养策略在重症患者.
- 需要进行前性研究来验证RHP的实用性作为准备养的指标.
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