在重症期间增加肠道蛋白质:TARGET蛋白随机临床试验
Matthew J Summers1,2, Lee-Anne S Chapple1,2,3,4, Amalia Karahalios5,6
1Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia.
在重症患者中增加肠道蛋白质并没有改善存活率或减少再入院. 在接受高蛋白肠道营养的重症患者中,该研究没有发现90天的活期和没有住院的显著益处.
科学领域:
- 危急护理医学
- 临床营养
- 重症监护室的管理
背景情况:
- 目前的指导方针建议重症患者增加蛋白质摄入量.
- 然而,增强肠道蛋白对患者结果的实际影响尚不清楚.
- 这种不确定性需要严格的临床试验来指导实践.
研究的目的:
- 调查重症患者增加肠道蛋白质摄入量是否能改善结果.
- 具体来说,要确定蛋白质含量是否会增加90天的生存时间.
- 评估对各种次要临床结果的影响.
主要方法:
- 在澳大利亚和新西兰的8个重症监护室进行了集群随机交叉开放试验.
- 接受肠道营养的重症患者被分别分配给增强蛋白质 (100 g/ l) 或常规蛋白质 (63 g/ l) 配方,持续12个月.
- 主要测量结果是第90天活着并从指数医院释放,评估了多个次要结果.
主要成果:
- 共有3397名患者被纳入该试验.
- 在第90天生存和从医院出院的日数中位数在各组之间相似 (62天增强 vs 64天通常).
- 没有观察到90日生存率或关键次要结果,如通风持续时间,ICU/住院时间或气管切除和置换治疗率的显著差异.
结论:
- 在危急病患者中增加肠道蛋白质并没有显著改善第90天的存活和没有住院的初级结果.
- 这些发现表明,目前增加蛋白质的建议可能不会改善该患者群体的临床结果.
- 可能需要进一步的研究来确定可能从增加蛋白质摄入中受益的危急病患者的特定亚组.
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