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阿尔维德·弗雷特林德讲座2024年 危急儿童的最佳营养:少可以是多吗?
1Department of Neonatal and Paediatric Intensive Care, Division of Pediatric Intensive Care, ErasmusMC, Dr Molewaterplein 40, 3015 GJ, Rotterdam, the Netherlands.
Clinical nutrition (Edinburgh, Scotland)
|July 16, 2025
概括
重症儿童不会从早期的积极营养支持中受益. 一项研究发现,暂时的宏观营养素缺乏是安全和潜在的有益,挑战了以前的临床实践.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 临床营养研究临床营养研究
- 对危急疾病的代谢反应.
背景情况:
- 长期以来的教条建议对重症儿童提供积极的营养支持,包括高蛋白摄入量,以防止代谢.
- 这种方法是基于这样的假设,即早期和最大的营养提供改善了儿科重症监护室 (PICU) 患者的结果.
- 新出现的证据质疑了这种传统营养策略的有效性和安全性.
研究的目的:
- 挑战在重症儿童中早期积极营养支持的既定做法.
- 调查早期与晚期亲肠道营养对儿科重症监护病房 (PICU) 临床结果的影响.
- 评估容忍暂时的宏观营养素缺乏的安全性和潜在益处.
主要方法:
- 进行了一项多中心随机对照试验,PEPaNIC (儿科重症监护病房的早期与晚期亲肠营养).
- 这项研究将肠道营养早期补充与肠外营养与PICU患者晚期补充进行了比较.
- 研究因果关系以确定营养时间和成分的影响.
主要成果:
- 在PICU入院后的第一周内,早期的亲肠道营养补充剂并没有改善临床结果.
- 耐受暂时的宏观营养素缺乏被发现是危急儿童的安全.
- 这些发现表明,拒绝积极的早期营养干预有潜在的益处.
结论:
- 早期积极营养支持的教条,特别是高蛋白摄入量,在重症儿童受到新的证据的挑战.
- 早期的亲肠道营养不提高临床结果,也可能不优于受控的宏观营养素缺乏.
- 基于这些发现,儿科重症监护营养的临床实践指南可能需要修订.
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