[1]冯筱青,白 倩,李 利,等.等热卡情况下不同蛋白供给对于重症病人临床结局的影响[J].肠外与肠内营养杂志,2019,(04):198-202.[doi:DOI : 10.16151/j.1007-810x.2019.04.002]
　FENG Xiao-qing,BAI Qian,LI Li,et al.Effects of different protein supplies on clinical outcomes in severe patients with the same calorie[J].PARENTERAL & ENTERAL NUTRITION,2019,(04):198-202.[doi:DOI : 10.16151/j.1007-810x.2019.04.002]
点击复制

等热卡情况下不同蛋白供给对于重症病人临床结局的影响
分享到：

《肠外与肠内营养》杂志[ISSN:1007-810X/CN:32-1477/R]

卷:
期数:
2019年04期
页码:
198-202
栏目:
论著
出版日期:
2019-07-10

文章信息/Info

Title:
Effects of different protein supplies on clinical outcomes in severe patients with the same calorie
作者:
冯筱青; 白 倩; 李 利; 邹 洁; 刘 俊; 王 建
陆军军医大学新桥医院营养科，重庆 400037
Author(s):
FENG Xiao-qing;  BAI Qian;  LI Li;  ZOU Jie;  LIU Jun;  WANG Jian
Department of Nutrition, Xinqiao Hospital, Army Medical University, Chongqing 400037, China
关键词:
危重症 ; 氮热比 ; 营养治疗效果 ; 脏器功能
Keywords:
Critically ill;  Nitrogen energy ratio;  Nutritional therapy effect;  Organ function
分类号:
R459.3
DOI:
DOI : 10.16151/j.1007-810x.2019.04.002
文献标志码:
A
摘要:
目的：比较给予危重症病人同等热卡不同蛋白的营养治疗方案对脏器功能及营养状况的改善效果。 方法：回顾性分析 260例行肠外营养和（或）肠内营养治疗 7 d及 7 d以上的危重症病人。其中氮热比 1:100 ~133组 69例、氮热比 1:133 ~ 167组 129例、氮热比 1:168 ~ 200组 62例。 结果：营养治疗前后，各组危重症病人自身对比，血清平均 TP、ALB、PA、TLC均明显升高（P < 0.01），血清平均 ALT、AST、SCr无明显差异（P > 0.05）。其中氮热比 1:100 ~ 133组的危重症病人营养治疗后的 TP、ALB、PA、TLC高于其余两组（P < 0.05），呼吸机脱机时间短于其余两组（P < 0.05）。血清平均 ALT、AST、SCr、住院时间、住院总费用各组间差异无统计学意义。 结论：氮热比 1:100 ~ 133组的危重症病人营养治疗效果优于氮热比偏高组，且并不增加病人脏器负担。
Abstract:
Objective: To compare the effects of nutritional treatment regimens with different proteins of the same calorie on the improvement of nutritional status and organ functions in critically ill patients. Methods: The clinical data of 260 critically ill patients treated with parenteral and/or enteral nutrition for 7 or more days were retrospectively analyzed. Prescriptions with ratio of nitrogen and calories of either 1:100 ~ 133, 1:133 ~ 167, or 1:168 ~ 200 are 69 cases, 129 cases and 62 cases, separately. Results: After the nutrition treatment, the serum average levels of total protein (TP), albumin (ALB), prealbumin (PA) and total lymphocyte counts (TLC) were significantly increased than before treatment(P < 0.01), while the mean serum alanine transaminase (ALT), aspartate transaminase (AST) and serum creatinine (SCr) were not significantly different (P > 0.05). The levels of serum TP, ALB, PA, TLC in critically ill patients with the nitrogen-calorie ratio of 1:100 ~ 133 were significantly higher than in the other two groups (P < 0.05) after nutritional treatment, and the duration of mechanical ventilation was significantly shorter than in the other two groups (P < 0.05). There were no significant differences in the levels of mean serum ALT、AST and SCr, neither for the hospitalization time and the total hospitalization expenses in these groups. Conclusion: The nutrition prescriptions with the nitrogen-calorie ratio of 1:100 ~ 133 has a better therapeutic effect, and no increase in organs burden.

参考文献/References:


[1] Hartl R, Gerber LM, Ni Q, et al. Effect of early nutrition on deaths due to severe traumatic brain injury. J Neurosurg, 2008,109(1): 50-56.
[2] 伍晓汀, 陈 博 . 临床营养支持策略的变迁 . 中国实用外科杂志, 2011, 31(1): 25-28.
[3] 许 媛 . 围手术期营养支持规范管理 . 中国实用外科杂志,2014, 34(2): 143-145.
[4] Lewis K, Alqahtani Z, Mcintyre L, et al. The efficacy and safety of prokinetic agents in critically ill patients receiving enteral nutrition: a systematic review and meta-analysis of randomized trials. Critical Care, 2016, 20(1): 259.
[5] McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine ( SCCM )and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N). JPEN J Parenter Enteral Nutr, 2016, 40( 2) : 159-211.
[6] 王新颖, 李 宁, 黎介寿 . 规范化营养支持在外科治疗中的地位 . 外科理论与实践, 2014, 19(1): 16-20.
[7] Weijs PJ, Cynober L, DeLegge M, et al. Proteins and amino acidsare fundamental to optimal nutrition support in critically ill patients. Crit Care, 2014, 18(6): 591.
[8] Alberda C, Gramlich L, Jones N, et al. The relationship between nutritional intake and clinical outcomes in critically ill patients:results of an international multicenter observational study. Intensive Care Med, 2009, 35(10): 1728-1737.
[9] Heyland DK, Cahill N, Day AG. Optimal amount of calories for critically ill patients: depends on how you slice the cake!. Crit Care Med, 2011, 39(12): 2619-2626.
[10] Compher C, Chittams J, Sammarco T, et al. Greater protein and energy intake may be associated with improved mortality in higher risk critically ill patients: a multicenter, multinational observational study. Crit Care Med, 2017, 45(2): 156-163.
[11] Allingstrup MJ, Esmailzadeh N, Wilkens Knudsen A, et al. Provision of protein and energy in relation to measured requirements in intensive care patients. Clin Nutr, 2012,31(4):462-468.
[12] Elke G, Wang M, Weiler N, et al. Close to recommended caloric and protein intake by enteral nutrition is associated with better clinical outcome of critically ill septic patients: secondary analysis of a large international nutrition database. Crit Care,2014, 18(1): R29.
[13] Nicolo M, Heyland DK, Chittams J, et al. Clinical outcomes related to protein delivery in a critically ill population: a multicenter, multinational observation study. J Parenter Enteral Nutr, 2016, 40(1): 45-51.
[14] Tian F, Gao XJ, Wu C, et al. Initial energy supplementation in critically ill patients receiving enteral nutrition: a systematic review and meta-analysis of randomized controlled trials. Asia Pac J Clin Nutr, 2017, 26(1): 11-19.
[15] Rugeles S, Villarraga-Angulo LG, Ariza-Gutierrez A, et al. Highprotein hypocaloric vs normocaloric enteral nutrition in critically ill patients: A randomized clinical trial. J Crit Care, 2016, 35:110-114.

相似文献/References:

[1]解好好.高能量密度肠内营养：有益或有害？[J].肠外与肠内营养杂志,2019,(01):20.[doi:10.16151/j.1007-810x.2019.01.009]
[2]蒋小芝,王华伟,赵浩天 综述,等.骨骼肌超声在急危重症病人营养状态 评估中的应用骨骼肌超声在急危重症病人营养状态[J].肠外与肠内营养杂志,2019,(06):372.[doi:10.16151/j.1007-810x.2019.06.012]
　JIANG Xiao-zhi,WANG Hua-wei,ZHAO Hao-tian reviewing,et al.Application of skeletal muscle ultoassound in the assessment of ntritional status of critical patients[J].PARENTERAL & ENTERAL NUTRITION,2019,(04):372.[doi:10.16151/j.1007-810x.2019.06.012]
[3]任宏生.美国重症医学临床实践观察[J].肠外与肠内营养杂志,2020,(01):5.[doi:10.16151/j.1007-810x.2020.01.002]
[4]叶向红,宫雪梅,王慧君,等.早期肠内营养耐受性分级干预在重症病人中 的应用[J].肠外与肠内营养杂志,2020,(02):89.[doi:10.16151/j.1007-810x.2020.02.006]
　YE Xiang-hong,GONG Xue-mei,WANG Hui-jun,et al.The application of improved grading management on early enteral nutrition tolerance in critically ill patients[J].PARENTERAL & ENTERAL NUTRITION,2020,(04):89.[doi:10.16151/j.1007-810x.2020.02.006]
[5]高恒妙,钱素云.危重症儿童肠内营养时应关注的重点问题[J].肠外与肠内营养杂志,2020,(06):321.[doi:10.16151/j.1007-810x.2020.06.001]
[6]叶向红,宫雪梅,薛阳阳.早期肠内营养护理方案对重症病人热卡达标率及喂养不耐受的 前后对照研究[J].肠外与肠内营养杂志,2021,(04):230.[doi:10.16151/j.1007-810x.2021.04.009]
　YE Xiang-hong,GONG Xue-mei,XUE Yang-yang.The effects of a nurse-driven feeding protocol on target reaching rate and feeding tolerance in critically ill patients: A before and after study[J].PARENTERAL & ENTERAL NUTRITION,2021,(04):230.[doi:10.16151/j.1007-810x.2021.04.009]
[7]高 月,李梦璇,陈松林,等.益生菌对危重症病人预后影响的 Meta 分析[J].肠外与肠内营养杂志,2022,(03):139.[doi:DOI : 10.16151/j.1007-810x.2022.03.003]
　GAO Yue,LI Meng-xuan,CHEN Song-ling,et al.Effects of probiotics on the outcome of critically ill adult patients: a Metaanalysis[J].PARENTERAL & ENTERAL NUTRITION,2022,(04):139.[doi:DOI : 10.16151/j.1007-810x.2022.03.003]
[8]江 洁,罗 倩,朱宝华,等.床旁超声胃窦双径法预估胃残余量指导老年重症病人肠内营养实施的临床研究[J].肠外与肠内营养杂志,2022,(05):280.[doi:10.16151/j.1007-810x.2022.05.005]
　JIANG Jie,LUO Qian,ZHU Bao-hua,et al.Prediction of gastric residual volume by bedside ultrasound to guide the implementation of enteral nutrition in elderly critically ill patients[J].PARENTERAL & ENTERAL NUTRITION,2022,(04):280.[doi:10.16151/j.1007-810x.2022.05.005]
[9]何 杨,高 琴,林 晨,等.幽门后早期肠内营养在危重症病人临床应用中的疗效及安全性[J].肠外与肠内营养杂志,2023,(01):14.[doi:DOI : 10.16151/j.1007-810x.2023.01.006]
　HE Yang,GAO Qin,LIN Chen,et al.The efficacy and safety of early post-pyloric enteral nutrition in adult critically ill patients[J].PARENTERAL & ENTERAL NUTRITION,2023,(04):14.[doi:DOI : 10.16151/j.1007-810x.2023.01.006]

备注/Memo

备注/Memo:
作者简介 ：冯筱青，营养医师，医学学士，从事临床营养工作。E-mail:150233371@qq.com 通讯作者 ：王 建，Email: wangjian_1996@aliyun.com
更新日期/Last Update: 1900-01-01