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营养支持在机械通气延长患者成功撤机中的应用。

Nutritional support for successful weaning in patients undergoing prolonged mechanical ventilation.

机构信息

Institute of Medicine, Chung Shan Medical University, Taichung, 402, Taiwan, ROC.

Department of Nutrition, Chung Shan Medical University Hospital, Taichung, 402, Taiwan, ROC.

出版信息

Sci Rep. 2022 Jul 14;12(1):12044. doi: 10.1038/s41598-022-15917-w.

Abstract

Successful weaning from ventilators not only improves the quality of life of patients, but also reduces medical expenses. The aim of this study was to explore the association between nutritional provision and successful ventilator weaning. In this retrospective study data from the Respiratory Care Center of Chung Shan Medical University Hospital between October, 2017 and July, 2019 on patient characteristics, amount of nutrition delivered, and clinical outcomes were retrieved. A total of 280 ventilated patients were enrolled and divided into successful extubation and failed weaning groups. There were 178 males (63.6%) and 102 females (36.4%) with a mean age of 67.3 ± 16.9 years. The successful extubation group consisted of patients who tended towards ideal body weight during the weaning process (BMI 23.9 ± 5.0 versus 22.7 ± 4.8 kg/m, p < 0.001). Patients from both groups initially received the same nutritional intervention, while patients of successful extubation received significantly more calories and protein after weaning (23.8 ± 7.8 kcal versus 27.8 ± 9.1 kcal, p < 0.001 and 0.97 ± 0.36 g versus 1.14 ± 0.42 g, p < 0.001). Successful weaning was associated with higher survival rate (p = 0.016), shortened hospital stay (p = 0.001), and reduced medical costs (p < 0.001). Overall, nutritional support with high calories and protein was associated with the probability of successful ventilator weaning in patients undergoing prolonged mechanical ventilation. Adequate nutrition is a determinant of successful ventilator weaning.

摘要

成功脱离呼吸机不仅可以提高患者的生活质量,还可以降低医疗费用。本研究旨在探讨营养供给与成功脱机的关系。本回顾性研究收集了 2017 年 10 月至 2019 年 7 月期间,在中山医学大学附设医院呼吸照护中心的患者特征、营养供给量和临床结局等数据。共纳入 280 例接受机械通气的患者,分为成功拔管组和脱机失败组。男性 178 例(63.6%),女性 102 例(36.4%),平均年龄 67.3±16.9 岁。成功拔管组患者在脱机过程中倾向于达到理想体重(BMI 23.9±5.0 与 22.7±4.8 kg/m²,p<0.001)。两组患者最初接受相同的营养干预,而成功拔管组患者在脱机后接受了更多的热量和蛋白质(23.8±7.8 kcal 与 27.8±9.1 kcal,p<0.001 和 0.97±0.36 g 与 1.14±0.42 g,p<0.001)。成功脱机与更高的生存率(p=0.016)、更短的住院时间(p=0.001)和更低的医疗费用(p<0.001)相关。总之,高热量和高蛋白的营养支持与长期机械通气患者成功脱机的概率相关。充足的营养是成功脱机的决定因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7031/9283331/90f955ee6756/41598_2022_15917_Fig1_HTML.jpg

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