在危急疾病中优化蛋白质:g/无脂肪质量是关键吗?
Kensuke Nakamura1, Hidehiko Nakano2, Naoki Kanda2
1Division of Disaster and Emergency Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe City, Hyogo 650-0017, Japan; Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki 317-0077, Japan.
Clinical nutrition (Edinburgh, Scotland)
|November 13, 2025
概括
接受蛋白质治疗的重症患者可能会出现血尿素 (BUN) 的升高. 肌肉体积影响BUN水平,这表明蛋白质点应该考虑肌肉质量,以获得更好的患者结果.
科学领域:
- 关键护理医学 关键护理医学
- 营养支持 营养支持
- 脏生理学 脏生理学
背景情况:
- 血尿酸 (BUN) 的升高是重症患者蛋白质负载的潜在不良影响.
- 肌肉体积对BUN轨迹以及功能的影响尚未完全理解.
研究的目的:
- 为了研究肌肉体积和BUN度之间的关系,在接受不同蛋白质输送目标的重症患者中.
- 为了确定肌肉体积是否影响蛋白质管理期间BUN水平的轨迹.
主要方法:
- 对一项前性研究的后期分析,该研究涉及10天的ICU患者,其蛋白质标为0.9和1.8g/kg/day.
- 排除接受脏替代疗法的患者.
- 肌体积 (FMV) 通过入院时的CT扫描进行评估;每日BUN和蛋白质输送记录.
主要成果:
- 较低的肌肉体积与略高的BUN轨迹相关.
- 总蛋白质输送与FMV的比率与第10天的BUN正相关 (r=0.37,p=0.0007).
- 每个FMV的蛋白质摄入量与较高的BUN (系数0.07,p=0.02) 有显著的关联,与相对体重的蛋白质摄入量不同.
结论:
- 蛋白质输送与肌肉体积的比率与重症患者的BUN升高有关.
- 基于肌肉体积的个性化蛋白质标 (例如,每无脂肪质量的克) 可能可以优化BUN管理.
- 年龄和基线肌素也是BUN水平的显著预测因素.
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