重症儿科患者的高密度肠道配方:系统性审查和元分析
Natsuhiro Yamamoto1, Yoshiyuki Shimizu2, Keichiro Shimoyama3
1Department of Anesthesiology and Critical Care Medicine, Yokohama City University School of Medicine, Kanagawa, Japan.
Clinical nutrition ESPEN
|March 20, 2025
概括
高密度肠道配方在重症婴儿中显著改善了体重年龄Z分数 (WAZ). 该策略支持营养需求,同时在脆弱的儿科患者中管理液体限制.
科学领域:
- 儿科重症监护营养 儿科重症监护营养
- 新生儿和婴儿重症监护室
- 临床营养研究临床营养研究
背景情况:
- 重症儿科患者,尤其是婴儿,面临高营养不良风险.
- 流体过载是一个问题,需要限制用水.
- 能量或蛋白质密度高的肠道配方提供了一种双重方法来满足营养需求和流体限制.
研究的目的:
- 在重症儿科患者中系统地审查和元分析能量或蛋白质密度高的肠道配方的疗效和安全性.
- 评估高密度配方对死亡率,停留时间,通风持续时间,不良事件和营养状况的影响.
主要方法:
- 通过全面的数据库搜索 (MEDLINE,Cochrane,Igaku-Chuo-Zasshi) 确定的随机对照试验 (RCT) 的系统审查和元分析,直到2023年4月.
- 包括RCT比较高密度 (>0.9千卡/毫升) 和标准密度 (0.67至<0.9千卡/毫升) 肠道配方在重症儿童.
- 主要结局:死亡率. 二次结局:在ICU停留的时间,机械通风的持续时间,不良事件和体重与年龄的Z分数 (WAZ). 使用GRADE评估的证据确定性.
主要成果:
- 分析了7项涉及542名患者的研究;大多数患者患有先天性心脏病或病毒引起的呼吸衰竭.
- 在死亡率 (RR 2.05,95% CI [0.76-5.50]),ICU停留,住院或通风持续时间方面没有发现显著差异.
- 高密度配方显著增加了体重与年龄的Z分数 (MD 0.61,95% CI [0.28-0.94]),证据的确定性较低.
结论:
- 使用高密度肠道配方有效改善重症儿科患者的体重与年龄的Z分数.
- 需要进一步的研究来提高这些发现的确定性,并指导临床实践.
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