重症患者营养治疗处方的演变

Evolution of nutritional therapy prescription in critically ill patients.

作者信息

Dock-Nascimento D Borges, Tavares V Maeve, de Aguilar-Nascimento J E

机构信息

Multidisciplinary Nutritional Therapy Team, Julio Muller Universitary Hospital, University of Mato Grosso, Brasil.

出版信息

Nutr Hosp. 2005 Sep-Oct;20(5):343-7.

PMID:16229402

Abstract

AIM

The aim of this study was to investigate factors that may affect the evolution of the caloric prescription in critically ill patients. Local: Intensive care unit patients.

PATIENTS

60 patients (33 M and 27 F); median age = 49 (1593) y were followed prospectively. They were divided in three groups according to the diagnostic: (a) trauma (n=20); (b) surgical (n=22), and 3) medical treatment (n=18). Forty-and-one (68.3%) patients received enteral nutrition (EN), 17 (28.3%) parenteral nutrition (TPN), and 2 (3.4%) TNP and EN. Nutritional status was graded B or C by global subjective evaluation.

METHODS

Endpoints of the study were the time to begin the nutritional support, success or failure of the caloric prescription, and the evolution of the planned caloric prescription. The caloric evolution was considered as success if the prescription for the patient attained: (a) 25% of the caloric requirements on the 1st day; (b) 50% until the 3rd day; (c) 75% until the 6th day; and (e) 100% until the 10th day of the beginning of the support.

RESULTS

In 54 (90%) patients, the nutritional support has begun until 48 h after admission and in 73.3% (44 patients), until the first 24 hours. EN was most prescribed for both trauma and medical patients while NPT was most used for surgical patients (p < 0.01). Success in caloric prescription was obtained in 73.3% (44) of the patients. There was no statistical difference for the success on the evolution of the prescription related to sex, age, diagnostic group, albumin level, type of support, mortality, use of fiber or glutamine. Success was attained earlier in patients without (median = 3.8 [95% CI, 5.7-16.7] days) than with (11.2 [95% CI, 5.7-16.7] days; p < 0.01) mechanical ventilation.

CONCLUSIONS

Early nutritional support and success on the evolution of the caloric prescription can be accomplished in most critically ill patients. Evolution of the caloric prescription was slower in mechanical ventilated patients.

摘要

目的

本研究旨在调查可能影响重症患者热量处方演变的因素。地点：重症监护病房患者。

患者

前瞻性随访60例患者（33例男性和27例女性）；中位年龄 = 49（15 - 93）岁。根据诊断将他们分为三组：（a）创伤组（n = 20）；（b）手术组（n = 22），以及（c）内科治疗组（n = 18）。41例（68.3%）患者接受肠内营养（EN），17例（28.3%）接受肠外营养（TPN），2例（3.4%）接受全胃肠外营养（TNP）和肠内营养。通过整体主观评估将营养状况分为B级或C级。

方法

研究终点为开始营养支持的时间、热量处方的成功或失败以及计划热量处方的演变。如果患者的处方达到以下标准，则热量演变被视为成功：（a）第1天达到热量需求的25%；（b）第3天达到50%；（c）第6天达到75%；以及（e）支持开始后第10天达到100%。

结果

54例（90%）患者在入院后48小时内开始营养支持，73.3%（44例）患者在最初24小时内开始。创伤患者和内科患者最常采用肠内营养，而手术患者最常采用肠外营养（p < 0.01）。73.3%（44例）的患者热量处方成功。在处方演变的成功率方面，与性别、年龄、诊断组、白蛋白水平、支持类型、死亡率、纤维或谷氨酰胺的使用无关，无统计学差异。未接受机械通气的患者（中位值 = 3.8 [95%可信区间，5.7 - 16.7]天）比接受机械通气的患者（11.2 [95%可信区间，5.7 - 16.7]天；p < 0.01）更早获得成功。