重大创伤后入住重症监护病房患者的肠内营养供给：谁面临风险以及有何影响？
Enteral nutrition delivery in patients admitted to a critical care unit following major trauma: Who's at risk and what's the impact?
作者信息
Davies Carys, Johansson Lina, Brett Stephen J, Cole Elaine
机构信息
Department of Surgery and Cancer, Imperial College London, London.
Department of Nutrition and Dietetics, Imperial College Healthcare NHS Trust, London.
出版信息
J Intensive Care Soc. 2025 Jun 29:17511437251349679. doi: 10.1177/17511437251349679.
BACKGROUND
Hypermetabolism and enteral nutrition delivery challenges, result in trauma patients, becoming malnourished during their hospital, admission. This study aimed to explore enteral nutrition delivery, predictors of suboptimal delivery and the relationship with clinical outcomes in patients admitted to a critical care unit following major trauma.
METHODS
An exploration of nutrition related data collected as part of a multicentre prospective major trauma study was conducted. Nutrition related data included anthropometry, nutrition risk screening, feeding route, nutrition products, target volume, nutrition delivery and causes of enteral feeding interruptions. Multivariate logistic regression analysis was used to evaluate the strongest associations with suboptimal nutrition delivery.
RESULTS
Of 1036 participants, 71% ( = 732) required enteral nutrition for a mean of 15.7 (7.9) days. Suboptimal nutrition delivery was prevalent throughout the admission. Mean energy target was 23.8 (6.37) versus 15.81 (3.43) kcal/kg/day delivered ( < 0.001). Mean protein target was 1.27 (0.34) versus 0.89 (0.48) g/kg/day delivered ( < 0.001). Factors associated with suboptimal nutrition delivery included male sex (OR, 1.82, 95% CI 1.27-2.60; < 0.001), traumatic brain injury (OR, 1.67, 95% CI 1.16-2.40; = 0.006) or high NUTRIC score (OR, 1.17, 95% CI 1.08-1.27; < 0.001); early enteral nutrition reduced the risk of underfeeding (OR, 0.49, 95% CI 0.30-0.81; = 0.006). Lower energy and protein delivery were associated with increased days of mechanical ventilation ( < 0.001) and longer length of stay in both the critical care unit and overall hospital stay ( < 0.001).
CONCLUSION
Trauma patients experience inadequate enteral nutrition delivery which potentially negatively impacts clinical outcomes. Additional investigation is required to further understand the barriers and facilitators to adequate nutrition provision in critically ill trauma patients.
背景
高代谢及肠内营养供给挑战导致创伤患者在住院期间出现营养不良。本研究旨在探讨创伤重症监护病房患者的肠内营养供给情况、供给不足的预测因素及其与临床结局的关系。
方法
对一项多中心前瞻性重大创伤研究中收集的营养相关数据进行分析。营养相关数据包括人体测量学指标、营养风险筛查、喂养途径、营养产品、目标量、营养供给及肠内喂养中断原因。采用多因素逻辑回归分析评估与营养供给不足相关性最强的因素。
结果
1036名参与者中，71%（n = 732）需要肠内营养，平均时长为15.7（7.9）天。在整个住院期间，营养供给不足情况普遍存在。平均能量目标为23.8（6.37）kcal/kg/天，而实际供给量为15.81（3.43）kcal/kg/天（P < 0.001）。平均蛋白质目标为1.27（0.34）g/kg/天，实际供给量为0.89（0.48）g/kg/天（P < 0.001）。与营养供给不足相关的因素包括男性（比值比[OR]，1.82，95%置信区间[CI] 1.27 - 2.60；P < 0.001）、创伤性脑损伤（OR，1.67，95% CI 1.16 - 2.40；P = 0.006）或高营养风险评分（OR，1.17，95% CI 1.08 - 1.27；P < 0.001）；早期肠内营养可降低喂养不足风险（OR，0.49，95% CI 0.30 - 0.81；P = 0.006）。能量和蛋白质供给量较低与机械通气天数增加（P < 0.001）以及在重症监护病房和整个住院期间的住院时间延长相关（P < 0.001）。
结论
创伤患者存在肠内营养供给不足的情况，这可能对临床结局产生负面影响。需要进一步研究以深入了解重症创伤患者充足营养供给的障碍和促进因素。
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