Department of Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tiqva, 49100, Israel.
Clin Nutr ESPEN. 2020 Aug;38:3-8. doi: 10.1016/j.clnesp.2020.03.026. Epub 2020 May 31.
The critically ill patient is highly catabolic, loosing significant amounts of protein and muscle. This proteolysis may induce a loss of 20% of the muscle mass in 10 days of hospitalization. Muscle loss may be assessed measuring urinary nitrogen excretion, muscle mass by ultrasound, bioimpedance, computerized tomography or MRI. To reduce the negative nitrogen balance, protein can be administrated enterally, or parenterally through amino acids as a part of parenteral nutrition. ESPEN guidelines recommend to administer 1.3 g/kg/day of protein to critically ill patients but this recommendation should be adapted according to clinical conditions. Elderly, obese, trauma, burn, acute kidney injury patients should receive larger amount of protein.
危重症患者处于高度分解代谢状态，会大量丢失蛋白质和肌肉。这种蛋白水解作用可能会导致住院 10 天内肌肉质量减少 20%。肌肉损失可以通过测量尿氮排泄、超声、生物阻抗、计算机断层扫描或磁共振成像来评估。为了减少负氮平衡，可以通过肠内或肠外途径给予氨基酸作为肠外营养的一部分来补充蛋白质。ESPEN 指南建议危重症患者每天给予 1.3 g/kg 的蛋白质，但应根据临床情况进行调整。老年、肥胖、创伤、烧伤、急性肾损伤患者应摄入更多的蛋白质。
