肠外营养中的含氮量：一家综合医院的四年经验。危重症患者的特殊性。

Nitrogenous content in parenteral nutrition: a four-year experience in a general hospital. Critically-ill patient specificity.

作者信息

Villalobos-Gámez Juan Luis, Lara-Ramos Carlos, Domínguez-Rivas Yolanda, Vallejo-Báez Antonio, Cota-Delgado Francisco, Márquez-Fernández Efrén, García-Almeida José Manuel, López-Medina José Antonio, Rioja-Vázquez Rosalía, Santacreu-Regí Albert, Rius-Díaz Francisca, Mínguez-Mañanes Alfredo

机构信息

Hospital Universitario Virgen de la Victoria. Málaga.

出版信息

Nutr Hosp. 2017 Jun 5;34(3):555-561. doi: 10.20960/nh.699.

DOI:10.20960/nh.699

PMID:28627189

Abstract

INTRODUCTION

There have been several studies focusing on caloric intake during the last years, while protein content relevance has been underestimated. Some recent evidence has shown that protein deficiency has also an impact on patient outcomes. We have studied the nitrogen (N) content in parenteral nutrition (PN) bags administered to adult patients in a Spanish tertiary level hospital for four years.

MATERIAL AND METHODS

Patients who received parenteral nutrition in the general ward and Intensive Care Unit (ICU) were recorded. Caloric and protein content were registered and adjusted to weight and length of stay. Data were compared among three group of patients: those in the general ward, those in the ICU and those requiring renal replacement therapy (RRT). The one-factor analysis of variance (ANOVA) test was used after checking data normality and homoscedasticity.

RESULTS

There was an increase in the mean g N/stay year after year (p < 0.01) from 14 to 15.5 g, with a decrease in non-protein caloric content (p < 0.001) from 111.6 to 101.8 kcal/g N. The range was established from 4.1 to 32.6 g. PN diets with ≥ 18 g N% ranged from 12.8% (2010) to 19.6% (2013). There were significant differences among the groups when comparing the variable g N/stay (p < 0.0001): 13.5 general ward vs15.9 ICU patients vs17.6 ICU with RRT, also when referring to adjusted weight.

CONCLUSIONS

According to most recent recommendations nitrogen has been provided in higher amounts than previously, especially in critical care patients with RRT.

摘要

引言

在过去几年中，有多项研究聚焦于热量摄入，而蛋白质含量的相关性却一直被低估。最近的一些证据表明，蛋白质缺乏也会对患者的预后产生影响。我们对一家西班牙三级医院四年间给予成年患者的肠外营养（PN）袋中的氮（N）含量进行了研究。

材料与方法

记录在普通病房和重症监护病房（ICU）接受肠外营养的患者。记录热量和蛋白质含量，并根据体重和住院时间进行调整。将患者分为三组进行数据比较：普通病房患者、ICU患者和需要肾脏替代治疗（RRT）的患者。在检查数据正态性和同方差性后，使用单因素方差分析（ANOVA）检验。

结果

平均每住院年的氮摄入量（g N/住院年）逐年增加（p < 0.01），从14 g增加到15.5 g，而非蛋白质热量含量下降（p < 0.001），从111.6 kcal/g N降至101.8 kcal/g N。范围为4.1至32.6 g。氮含量≥1 g N%的PN饮食占比从2010年的12.8%到2013年的19.6%不等。比较g N/住院变量时，各组之间存在显著差异（p < 0.0001）：普通病房患者为13.5，ICU患者为15.9，接受RRT的ICU患者为17.6，按调整体重计算时也是如此。