Crit Care Med:加大蛋白质和能量摄入对危重症患者死亡率的影响:一项多中心、国际观察研究

2017-06-29 MedSci MedSci原创

对危重病人营养摄入的利弊始终存在争议,而其原因可能归结于不同患者营养摄入风险不同所致。本研究的目的是探讨对于危重症患者来说,不同剂量的蛋白质或能量摄入对患者预后的影响,结果将以危重病患者营养风险得分进行评估。

对危重病人营养摄入的利弊始终存在争议,而其原因可能归结于不同患者营养摄入风险不同所致。本研究的目的是探讨对于危重症患者来说,不同剂量的蛋白质或能量摄入对患者预后的影响,结果将以危重病患者营养风险得分进行评估。

采用为前瞻性观察队列对来自202个ICU的2853名机械通气大于或等于4天的患者进行研究,其中1605名通气时间大于或等于12天的患者设置为一个研究子组。

使用Logistic回归和Cox比例风险回归分别对低风险组(危重病患者的营养风险< 5)和高风险组(危重症患者营养风险≥5)患者进行分析,评估入ICU后前12天给予营养支持的患者的死亡率和60天内转出ICU的时间。在高风险组患者,摄入更多蛋白质(4天组:比值比,0.93;95% CI,0.89-0.98;P = 0.003和12天组:比值比,0.90;95% CI,0.84-0.96;P = 0.003)和能量(4天组:比值比,0.93;95% CI 0.89-0.97;P<0.001和12天组:比值比,0.88;95% CI,0.83-0.94;P<0.001)后死亡率反而更低。在12天组,营养支持风险和疾病分类、死亡率、蛋白质和能量摄入有极大的关系,而在4天组内此种关联表现并不显着。在高风险组患者,摄入更多蛋白质(4天组:风险比,1.05;95% CI,1.01-1.09;P = 0.01和12天组:风险比,1.09;95% CI,1.03-1.16;P = 0.002)和能量(4天组:风险比,1.05;95% CI,1.01-1.09;P = 0.02和12天组:风险比,1.09;95% CI,1.03-1.16;P = 0.002)后转出ICU时间有下降趋势。在12天组,营养支持风险和存活率、蛋白和能量摄入有极大相关性,然而在4天组表现不显着。

从而我们可以得出结论:在高风险、ICU停留时间久的患者中,更多的营养摄入量可降低患者死亡率,并减少ICU住院时间,但在低风险的患者中这一差别并不显着。

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  5. 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  6. 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  7. 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