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早期足量蛋白质摄入对重症患者结局的影响

Effect of early enough protein intake on outcomes of critically ill patients
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摘要 目的探讨疾病早期及晚期蛋白质摄入量对重症患者结局的影响。方法采用前瞻性观察研究的方法,将2016年9月至2018年3月收住南京大学医学院附属鼓楼医院ICU的重症患者326例纳入研究,根据28d结局情况分为死亡组和存活组,以入ICU前3d蛋白质摄入量≥0.8g/(kg·d)定义为早期蛋白质达标(EPT),入ICU4~7d蛋白质摄入量≥0.8g/(Rg.d)定义为晚期蛋白质达标(LPT)。结果死亡组患者入ICU后D1、D3每日蛋白质摄入量以及D1~3累计蛋白质摄入量均明显高于存活组(P<0.05),但D2、D4、D5、D6、D7每日蛋白质摄入量以及D4~7、D1~7累计蛋白质摄入量两组差别无统计学意义(P>0.05).LPT达标组的死亡率最低,ERT+LPT均达标组的死亡率和ERT+LPT均不达标组的死亡率次之,EPT达标组的死亡率最高(P<0.05)。生存曲线分析显示仅EPT达标组生存时间明显低于仅LPT达标组(P<0.05)。年龄、性别、D1~7热量累计摄入量以及D1~7蛋白质累计摄入量均为死亡独立危险因素。结论重症患者早期低蛋白摄入有利于改善结局,联合后期足量蛋白质摄入可能进一步改善结局。 Objective To investigate the effects of protein intake in the early phase and later phase on the outcomes of critically ill patients. Methods A total of 326 critically ill patients admitted in intensive care unit of our hospital from September 2016 to March 2018 were enrolled in this prospective observational study. According to the 28-day prognosis of patients, they were divided into death group and survival group. Early protein target ( EPT) was defined as the daily protein intake≥0.8 g/( kg · d) on days 1 -3, and late protein target (LPT) was defined as the daily protein intake≥0.8 g/( k· d) on days 4-7. Results Daily protein intakes on day 1 and day 3 and cumulative protein intakes on days 1-3 were significantly higher in non-survivors than in the survivors (P<0.05), but daily protein intakes on day 2, 4, 5, 6 and 7 and cumulative protein intakes on days 4-7 and 1 -7 showed no significant difference between two groups (P>0.05). Hospital mortality was the lowest in the LPT group, the highest in the EPT, and in the middle in the EPT+LPT group and non-EPT+non-LPT group ( P<0.05 ). The survival curve analysis showed that the survival time of the EPT-only group was significantly lower than that of the LPT-only group (P<0.05). Multivariate analysis showed that age, sex, cumulative protein and caloric intakes on days 1 - 7 were the independent risk factors for mortality. Conclusion Early low protein intake is benefit for the outcomes of critically ill patients, and combined with adequate intake of protein in the later stage may further improve the outcomes.
作者 徐颖 梁培 虞文魁 朱章华 刘宁 董丹江 唐健 尤勇 王妍 陈鸣 刘洋 顾勤 Xu Ying;Liang Pei;Yu Wenkui;Zhu Zhanghua;Liu Ning;Dong Danjiang;Tang Jian;You Yong;Wang Yan;Chen Ming;Liu Yang;Gu Qin(Intensive Care Unit,Drum Tower Hospital Affiliated to Nanjing University School of Medicine,Nanjing 210008,China)
出处 《中华临床营养杂志》 CAS CSCD 2019年第3期133-137,共5页 Chinese Journal of Clinical Nutrition
关键词 重症患者 蛋白质摄入 热卡摄入 结局 Critically ill patients Protein intake Caloric intake Outcome
作者简介 通信作者:顾勤,E-mail: guqin6065@ 163.com.
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