在急性阶段和败血症结果中蛋白质和能量摄入之间的关联:回顾性队列研究
Ke-Li Wen1, Yun-Xing Cao1, Hu Du1
1Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
Scientific reports
|July 30, 2025
概括
在性休克患者急性阶段3-7天的能量摄入量增加与28天死亡率降低有关. 这种营养策略可能会改善毒症重症患者的治疗结果.
科学领域:
- 关键护理医学 关键护理医学
- 营养科学 营养科学
- 传染性疾病 传染性疾病
背景情况:
- 败血症带来了显著的死亡风险,营养状况在患者预后中起着至关重要的作用.
- 早期营养干预至关重要,但在急性阶段的最佳时间和目标仍在研究中.
- 2002年营养风险查 (NRS-2002) ≥3确定高风险患者,需要量身定制的营养支持.
研究的目的:
- 调查早期 (1-2天) 和晚期 (3-7天) 急性阶段的蛋白质和能量摄入量之间的关联以及败血症患者的预后.
- 确定影响高营养风险的败血症患者28天死亡率的因素.
- 探索营养治疗对二次感染和临床结果的影响.
主要方法:
- 一项队列研究涉及293名败血症休克患者和309名非休克败血症患者,NRS-2002≥3.
- 考克斯回归分析以确定与28天死亡率相关的因素.
- 卡普兰-梅尔分析评估实现能源目标对死亡率的影响.
主要成果:
- 在性休克患者中,在第3至第7天摄入更高的能量与28天死亡率较低显著相关 (HR,0.969;P=0.033).
- 在第3至第7天达到75%的能量目标与冲击患者28天死亡率降低相关 (P=0.040).
- 在非休克患者中,在第3至第7天达到能量摄入量的50%与较低的真菌和腹腔内感染发病率有关.
结论:
- 在晚期急性阶段 (3-7天) 增加能量摄入量对败血症休克患者有潜在的益处,特别是在死亡率方面.
- 营养治疗的时间和目标可能会对败血症休克患者和非休克患者的结果产生不同的影响.
- 虽然在晚期急性阶段的能量摄入可能不会影响停留时间或成本,但它在减少非冲击性败血症的特定感染类型方面显示出希望.
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