在危重病中减轻肌肉质量损失：营养和运动的作用。
Attenuating Muscle Mass Loss in Critical Illness: the Role of Nutrition and Exercise.
机构信息
Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
出版信息
Curr Osteoporos Rep. 2022 Oct;20(5):290-308. doi: 10.1007/s11914-022-00746-7. Epub 2022 Aug 31.
Abstract
PURPOSE OF REVIEW
Impaired recovery following an intensive care unit (ICU) admission is thought related to muscle wasting. Nutrition and physical activity are considered potential avenues to attenuate muscle wasting. The aim of this review was to present evidence for these interventions in attenuating muscle loss or improving strength and function.
RECENT FINDINGS
Randomised controlled trials on the impact of nutrition or physical activity interventions in critically ill adult patients on muscle mass, strength or function are presented. No nutrition intervention has shown an effect on strength or function, and the effect on muscle mass is conflicting. RCTs on the effect of physical activity demonstrate conflicting results; yet, there is a signal for improved strength and function with higher levels of physical activity, particularly when commenced early. Further research is needed to elucidate the impact of nutrition and physical activity on muscle mass, strength and function, particularly in combination.
摘要
目的综述
人们认为，重症监护病房（ICU）入住后恢复受损与肌肉减少有关。营养和身体活动被认为是减轻肌肉减少的潜在途径。本综述的目的是介绍这些干预措施在减轻肌肉损失或改善力量和功能方面的证据。
最近的发现
介绍了营养或身体活动干预对重症成年患者肌肉质量、力量或功能影响的随机对照试验。没有营养干预措施显示对力量或功能有影响，而对肌肉质量的影响则存在争议。关于身体活动效果的 RCT 结果相互矛盾；然而，较高水平的身体活动，特别是早期开始的身体活动，有改善力量和功能的信号。需要进一步的研究来阐明营养和身体活动对肌肉质量、力量和功能的影响，特别是两者结合的影响。
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2
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