Wade Charles E, Kozar Rosemary A, Dyer Carmel B, Bulger Eileen M, Mourtzakis Marina, Heyland Daren K
The University of Texas Health Science Center at Houston, Houston
The University of Texas Health Science Center at Houston, Houston.
JPEN J Parenter Enteral Nutr. 2015 May;39(4):449-55. doi: 10.1177/0148607114523450. Epub 2014 Feb 21.
As metabolism is often escalated following injury, severely injured trauma patients are at risk for underfeeding and adverse outcomes.
From an international database of 12,573 critically ill, adult mechanically ventilated patients, who received a minimum of 3 days of nutrition therapy, trauma patients were identified and nutrition practices and outcomes compared with nontrauma patients. Within the trauma population, we compared nutrition practices and outcomes of younger vs older patients.
There were 1279 (10.2%) trauma patients. They were younger, were predominantly male, had lower Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, and had an overall lower body mass index compared with nontrauma patients. Eighty percent of trauma patients received enteral feeding compared with 78% of nontrauma patients. Trauma patients were prescribed more calories and protein yet received similar amounts as nontrauma patients. Nutrition adequacy was reduced in both trauma and nontrauma patients. Survival was higher in trauma patients (86.6%) compared with nontrauma patients (71.8%). When patients who died were included as never discharged, trauma patients were more rapidly discharged from the intensive care unit (ICU) and hospital. Within the trauma population, 17.5% were elderly (≥65 years). The elderly had increased days of ventilation, ICU stay, and mortality compared with younger trauma patients. In a multivariable model, age and APACHE II score, but not nutrition adequacy, were associated with time to discharge alive from the hospital.
Significant nutrition deficits were noted in all patients. Elderly trauma patients have worse outcomes compared with younger patients. Further studies are necessary to evaluate whether increased nutrition intake can improve the outcomes of trauma patients, especially geriatric trauma patients.
由于受伤后代谢通常会加快，严重受伤的创伤患者存在营养摄入不足和不良后果的风险。
从一个包含12573名接受至少3天营养治疗的成年重症机械通气患者的国际数据库中识别出创伤患者，并将其营养实践和结果与非创伤患者进行比较。在创伤患者群体中，我们比较了年轻患者与老年患者的营养实践和结果。
共有1279名（10.2%）创伤患者。与非创伤患者相比，他们更年轻，男性居多，急性生理与慢性健康状况评分系统II（APACHE II）得分更低，总体体重指数也更低。80%的创伤患者接受肠内喂养，而非创伤患者为78%。创伤患者的热量和蛋白质处方量更多，但实际摄入量与非创伤患者相似。创伤患者和非创伤患者的营养充足率均降低。创伤患者的生存率（86.6%）高于非创伤患者（71.8%）。当将死亡患者视为未出院时，创伤患者从重症监护病房（ICU）和医院出院的速度更快。在创伤患者群体中，17.5%为老年人（≥65岁）。与年轻创伤患者相比，老年人的通气天数、ICU住院时间和死亡率均增加。在多变量模型中，年龄和APACHE II评分而非营养充足率与从医院存活出院的时间相关。
所有患者均存在明显的营养不足。与年轻患者相比，老年创伤患者的预后更差。有必要进一步研究以评估增加营养摄入量是否能改善创伤患者尤其是老年创伤患者的预后。
