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接受血管升压药治疗的危重症患者肠内和肠外营养途径的生存研究:重症监护医学信息集市-IV数据库分析

Survival study of enteral and parenteral nutrition pathways in critically ill patients receiving vasopressors: an analysis of the Medical Information Mart for Intensive Care-IV database.

作者信息

Sun Aqiao, Li Minling, Song Ye, Song Yinxue, Nan Jiayan

机构信息

Emergency Center, The First Affiliated Hospital of Xi 'an Jiaotong University, Xi 'an710061, People's Republic of China.

出版信息

Br J Nutr. 2024 Sep 16:1-12. doi: 10.1017/S0007114524001399.

DOI:10.1017/S0007114524001399
PMID:39279666
Abstract

This study compared survival outcomes between intensive care unit (ICU) patients receiving enteral nutrition (EN) and parenteral nutrition (PN) with vasopressor support, explored risk factors affecting clinical outcomes and established an evaluation model. Data from 1046 ICU patients receiving vasopressor therapy within 24 h from 2008 to 2019 were collected. Patients receiving nutritional therapy within 3 d of ICU admission were divided into EN or PN (including PN+EN) groups. Cox analysis and regression were used to determine relevant factors and establish a nomogram for predicting survival. The 28-d survival rate was significantly better in the EN group compared with the PN/PN+EN group. Risk factors included age, peripheral capillary oxygen saturation, red cell distribution width, international normalised ratio, potassium level, mean corpuscular Hg, myocardial infarction, liver disease, cancer status and nutritional status. The nomogram showed good predictive performance. In ICU patients receiving vasopressor drugs, patients receiving EN had a better survival rate than PN. Our nomogram had favourable predictive value for 28-d survival in patients. However, it needs further validation in prospective trials.

摘要

本研究比较了接受肠内营养(EN)和肠外营养(PN)并接受血管活性药物支持的重症监护病房(ICU)患者的生存结局,探讨了影响临床结局的危险因素,并建立了一个评估模型。收集了2008年至2019年期间1046例在24小时内接受血管活性药物治疗的ICU患者的数据。在ICU入院3天内接受营养治疗的患者被分为EN组或PN组(包括PN+EN)。采用Cox分析和回归分析来确定相关因素,并建立预测生存的列线图。与PN/PN+EN组相比,EN组的28天生存率显著更高。危险因素包括年龄、外周毛细血管血氧饱和度、红细胞分布宽度、国际标准化比值、血钾水平、平均红细胞血红蛋白、心肌梗死、肝脏疾病、癌症状态和营养状况。该列线图显示出良好的预测性能。在接受血管活性药物治疗的ICU患者中,接受EN的患者生存率高于PN。我们的列线图对患者的28天生存具有良好的预测价值。然而,它需要在前瞻性试验中进一步验证。

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