关于如何在重症监护室养重症儿童:一个缓慢转变的范式
Jan Gunst1, Ilse Vanhorebeek1, Sascha Cat Verbruggen2
1Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, Leuven, Belgium.
Clinical nutrition (Edinburgh, Scotland)
|February 13, 2025
概括
在儿科重症监护室 (PICU) 早期增强营养并没有改善结果,并增加了感染. 限制性食策略可能是有益的,激活禁食反应,同时防止缺陷.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 临床营养学 临床营养学
- 代谢研究的研究.
背景情况:
- 在儿科重症监护室 (PICU) 中的重症儿童经常出现厌食症和食不耐症,导致宏观营养素缺乏.
- 从历史上看,早期的肠道或肠外营养是为了改善这些患者的结果而启动的.
- 质疑了宏观营养素缺乏和结果之间的因果关系.
研究的目的:
- 调查在儿科重症监护病人的早期亲肠道营养补充剂,当肠道营养不足或禁用时,是否能改善结果.
- 确定早期增强营养和PICU环境中的患者结果之间的因果关系.
主要方法:
- 进行了多中心"儿科重症监护病房早期对晚期肠外营养"随机对照试验 (PEPaNIC-RCT).
- 在PICU的第一个星期,比较了早期的亲肠道营养补充剂与接受巨量营养素缺乏的情况.
主要成果:
- 与接受缺陷相比,早期的亲肠道营养补充并没有改善结果.
- 早期增强营养导致感染增加,器官支持延长,PICU停留时间更长,以及不良的神经发育结果.
- 在各个子组中观察到的危害与宏观营养素剂量有关,特别是氨基酸.
结论:
- 危急疾病儿童的早期增强营养不会改善结果,可能会造成伤害.
- 研究结果表明,在危急疾病的急性阶段,人们可能会转向更为严格的宏观营养素管理.
- 通过适当的微量营养素支持,激活禁食诱导的细胞修复可能是一个有益的策略.
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