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重症监护病房中危重病患者免疫调节营养素的评估。

Evaluation of immunomodulatory nutrients in critically ill patients in the intensive care unit.

作者信息

Ay Necmiye, Derbent Abdurrahim, Kiyak Huseyin, Salihoglu Ziya

机构信息

Department of Anesthesiology and Reanimation, T.R. Ministry of Health Basaksehir Cam and Sakura City Hospital, Istanbul, Turkiye.

Department of Anesthesiology and Reanimation, Ege University, Izmir, Turkiye.

出版信息

North Clin Istanb. 2022 Dec 23;9(6):557-564. doi: 10.14744/nci.2021.00908. eCollection 2022.

Abstract

OBJECTIVE

Glutamine and omega-3 fatty acids have been shown to decrease infection rates, antibiotic use, and hospital length of stay. However, whether giving immunonutrients to critically ill patients is beneficial remains controversial. In our study, we aimed to look at the effectiveness of parenteral unsaturated (omega-3) fatty acids and amino acid glutamine in patients with serious conditions in the intensive care unit (ICU).

METHODS

The data of patients, who received parenteral amino acid glutamine and unsaturated fatty acids (omega-3) in the ICU, were retrospectively analyzed. Eighty-four patients were classified with regard to the length of the immune modulatory nutrient treatment. Groups were constructed according to the length of the treatment in days: 9 days or more (Group I), 3-9 days (Group II), and <3 days (Group III). Demographic data, Acute Physiologic Assessment and Chronic Health Evaluation II Scores (APACHE-II), ICU and hospitalization periods, inotropic medication, 60-day mortality, serum biochemistry, and bacterial culture results were recorded. 60-day mortality, bacterial culture results, and number of days stayed in ICU were primary outcomes of interest.

RESULTS

Demographic data of the patients and APACHE-II scores among the groups were not significantly different from each other. ICU stay length, hospitalization length, positivity in bacterial cultures, and use of inotropic agents were significantly higher in Group I compare with other groups.

CONCLUSION

In the ICU, it was observed that patients with multiorgan failure using parenteral unsaturated fatty acids and amino acid glutamine had longer hospital and intensive care stay. It can be said that long-term use of antioxidants and immunonutrition does not have a beneficial effect in patients with multiple organ failure with high APACHE-II scores.

摘要

目的

谷氨酰胺和ω-3脂肪酸已被证明可降低感染率、抗生素使用量及住院时间。然而,给予重症患者免疫营养物质是否有益仍存在争议。在我们的研究中,我们旨在观察肠外不饱和(ω-3)脂肪酸和氨基酸谷氨酰胺对重症监护病房(ICU)中病情严重患者的有效性。

方法

对在ICU接受肠外氨基酸谷氨酰胺和不饱和脂肪酸(ω-3)的患者数据进行回顾性分析。根据免疫调节营养治疗的时长对84例患者进行分类。根据治疗天数构建分组:9天或更长时间(第一组)、3 - 9天(第二组)和<3天(第三组)。记录人口统计学数据、急性生理与慢性健康状况评分系统II(APACHE-II)评分、ICU住院时间和总住院时间、血管活性药物使用情况、60天死亡率、血清生化指标及细菌培养结果。60天死亡率、细菌培养结果及ICU住院天数是主要关注的结局指标。

结果

各组患者的人口统计学数据及APACHE-II评分无显著差异。与其他组相比,第一组的ICU住院时长、总住院时长、细菌培养阳性率及血管活性药物的使用显著更高。

结论

在ICU中,观察到使用肠外不饱和脂肪酸和氨基酸谷氨酰胺的多器官功能衰竭患者的住院和重症监护时间更长。可以说长期使用抗氧化剂和免疫营养对APACHE-II评分高的多器官功能衰竭患者没有有益影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a52d/9833380/76d9bfd7ab9a/NCI-9-557-g001.jpg

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