外科重症监护患者热量供应不足和蛋白质缺乏的临床结局
Clinical Outcomes of Inadequate Calorie Delivery and Protein Deficit in Surgical Intensive Care Patients.
作者信息
Yeh D Dante, Peev Miroslav P, Quraishi Sadeq A, Osler Polina, Chang Yuchiao, Rando Erin Gillis, Albano Caitlin, Darak Sharon, Velmahos George C
机构信息
D. Dante Yeh is an assistant professor of surgery, Harvard Medical School, Boston, Massachusetts, and a staff surgeon and intensivist, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts. Miroslav P. Peev is a general surgery resident, Tufts University, Boston, Massachusetts, and a research fellow, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital. Sadeq A. Quraishi is an assistant professor of anesthesia, Harvard Medical School, and a staff anesthetist and intensivist, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital. Polina Osler is a medical student, Harvard Medical School. Yuchiao Chang is an assistant professor of medicine, Harvard Medical School, and a statistician, Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital. Erin Gillis Rando, Caitlin Albano, and Sharon Darak are critical care dietitians, Department of Nutrition and Food Services, Massachusetts General Hospital. George C. Velmahos is professor of surgery, Harvard Medical School, and division chief, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital.
出版信息
Am J Crit Care. 2016 Jul;25(4):318-26. doi: 10.4037/ajcc2016584.
BACKGROUND
Adequate nutritional therapy in critically ill patients is integral to optimal outcome.
OBJECTIVE
To evaluate the association between cumulative macronutrient deficit and overall morbidity in surgical intensive care unit patients.
METHODS
Adult patients receiving enteral nutrition for more than 72 hours were included if they had no previous admission to the surgical intensive care unit, had received no enteral feedings before admission, had no intestinal obstruction or ileus, and survived 72 hours or more after admission. Data on demographics, outcomes, and nutritional intake during the unit stay were collected for up to 14 days until oral intake began, discharge, or death. Outcome variables included lengths of stay in the hospital and intensive care unit, days with no mechanical ventilation, complications, and mortality.
RESULTS
Of 94 participants, 71% were men, mean age was 63 years, and mean score on the Acute Physiology and Chronic Health Evaluation II was 14. Patients with high cumulative calorie deficit (≥ 6000 cal) and high protein deficit (≥ 300 g) had significantly fewer days with no mechanical ventilation (P < .001), longer unit stays (P < .001), longer hospital stays (P = .007), more total complications (P = .007), and more infectious complications (P = .009) than other participants. These associations remained significant in multivariable models after adjustments for age, sex, reason for admission, and propensity score of deficit. In-hospital and 30-day mortality did not differ.
CONCLUSIONS
Cumulative macronutrient deficits have important clinical outcomes in surgical intensive care patients.
背景
危重症患者充分的营养治疗是实现最佳预后不可或缺的一部分。
目的
评估手术重症监护病房患者累积宏量营养素缺乏与总体发病率之间的关联。
方法
纳入接受肠内营养超过72小时的成年患者，这些患者此前未入住过手术重症监护病房，入院前未接受过肠内喂养，无肠梗阻或肠麻痹，且入院后存活72小时或更长时间。收集患者在重症监护病房期间的人口统计学数据、预后数据和营养摄入数据，最长收集14天，直至开始经口进食、出院或死亡。预后变量包括住院时间和重症监护病房住院时间、无机械通气天数、并发症及死亡率。
结果
94名参与者中，71%为男性，平均年龄63岁，急性生理与慢性健康状况评分系统II的平均评分为14分。累积热量缺乏高（≥6000千卡）且蛋白质缺乏高（≥300克）的患者与其他参与者相比，无机械通气天数显著减少（P < .001），重症监护病房住院时间更长（P < .001），住院时间更长（P = .007），总并发症更多（P = .007），感染性并发症更多（P = .009）。在对年龄、性别、入院原因和缺乏倾向评分进行调整后的多变量模型中，这些关联仍然显著。住院死亡率和30天死亡率无差异。
结论
累积宏量营养素缺乏对手术重症监护患者的临床预后有重要影响。
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