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[慢性危重病患者营养支持的限制因素]

[Factors limiting nutritional support for patients in chronic critical illness].

作者信息

Yakovleva A V, Yakovlev A A, Lukyanets O B, Krylov K Yu, Shestopalov A E

机构信息

Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031, Moscow, Russian Federation.

Pirogov Russian National Research Medical University, 117997, Moscow, Russian Federation.

出版信息

Vopr Pitan. 2020;89(6):31-37. doi: 10.24411/0042-8833-2020-10076. Epub 2020 Nov 20.

Abstract

Patients in chronic critical illness after brain injury may experience various conditions that limit nutritional support. of this work is to analyze the factors limiting or hindering the provision of nutritional support (in particular, enteral clinical nutrition) in patients in chronic critical illness after brain damage. . This study is a prospective observational cohort study. In the course of the study, 47 patients (27 men and 20 women, mean age 52±18.4 years) in a chronic critical illness who were undergoing rehabilitation after brain damage and who had certain limitations in the provision of nutritional support were evaluated. The duration of the patients' stay in the intensive care unit was from 21 to 30 days. During hospitalization, adverse events and conditions were recorded in these patients, limiting the conduct of enteral clinical nutrition. . Among the undesirable phenomena and conditions limiting enteral nutrition, diarrheal syndrome most often developed - in 41.7% of patients (associated with the use of antibiotics in 25.0% of the examined). The second group in terms of frequency - the development of surgical pathology (of various etiology) - in 31.7% of patients, which attracted special attention, taking into account the neurological and/or neurosurgical nature of the underlying disease. At the same time, the appearance of a high residual volume of the stomach against the background of an increase in hydrocephalus developed only in 5.0% of cases. More attention should be paid to patients who are in the most severe physical condition, since they have a high probability of the occurrence of several factors at once that limit the use of clinical nutrition - this category of the studied sample included 19.1% of patients. . Strict adherence to the technology of enteral nutrition can increase the efficiency of enteral nutrition in patients in chronic critical condition.

摘要

脑损伤后慢性危重症患者可能会经历各种限制营养支持的情况。本研究的目的是分析脑损伤后慢性危重症患者中限制或阻碍营养支持(特别是肠内临床营养)提供的因素。本研究是一项前瞻性观察队列研究。在研究过程中,对47例慢性危重症患者(27例男性和20例女性,平均年龄52±18.4岁)进行了评估,这些患者脑损伤后正在接受康复治疗,且在营养支持提供方面存在一定限制。患者在重症监护病房的停留时间为21至30天。住院期间,记录了这些患者中限制肠内临床营养实施的不良事件和情况。在限制肠内营养的不良现象和情况中,腹泻综合征最常出现——41.7%的患者出现(25.0%的受检患者与使用抗生素有关)。按发生频率排序的第二组——各种病因的外科病理情况——在31.7%的患者中出现,考虑到基础疾病的神经学和/或神经外科性质,这引起了特别关注。同时,在脑积水增加的背景下胃残余量高的情况仅在5.0%的病例中出现。应更多关注身体状况最差的患者,因为他们同时出现多种限制临床营养使用因素的可能性很高——研究样本中的这一类别患者占19.1%。严格遵守肠内营养技术可提高慢性危重症患者肠内营养的效率。

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