允许性低热量营养支持在老年重症患者治疗中的临床价值
Clinical Value of Permissive Hypocaloric Nutritional Support in Elderly Critically Ill Patients
王庆 1李榕 1张茸 1韩亚军 1刘艳1
作者信息
- 1. 空军军医大学第一附属医院老年病科,西安 710032
- 折叠
摘要
目的 探讨允许性低热量营养支持在老年重症患者治疗中的应用价值.方法 选取西京医院2018年1-6月收治的符合条件的126例老年重症患者作为研究对象.根据随机数字表法分成标准热量组、试验A组和试验B组,各42例.患者在入院24～48 h内开始实施早期营养支持,7d后,标准热量组增加至30 kcal/(kg·d),试验A组增加至15 kcal/(kg·d),试验B组增加至9 kcal/(kg·d).比较各组的营养相关指标(白蛋白、前白蛋白及氮平衡)、急性胃肠道损伤(AGI)分级、序贯性器官功能衰竭(SOFA)评分、并发症和临床结局.结果 治疗后,试验A组和试验B组各项营养指标高于标准热量组(P＜0.05),且试验A组各项营养指标高于试验B组(P＜0.05);试验A组和试验B组的AGI分级评分与SOFA评分均低于标准热量组(P＜0.05),且试验A组AGI分级评分与SOFA评分均低于试验B组(P＜0.05).试验A组各并发症的发生率均小于标准热量组和试验B组(P＜0.05).试验A组治疗2周、4周后的死亡率及试验B组治疗4周后的死亡率均低于标准热量组(P＜0.05),试验A组治疗2周、4周后的死亡率均低于试验B组(P＜0.05).结论 允许性低热量营养支持对老年重症患者具有重要的临床意义,采用15 kcal/(kg·d)的热量水平能够改善老年重症患者的营养状况、保护胃肠道功能,有效控制并发症和病死率.
Abstract
Objective To investigate the value of permissive hypocaloric nutrition support in the treatment of elderly critically ill patients.Methods A total of 126 eligible elderly critically ill patients admitted to Xijing Hospital from January to June 2018 were se-lected as the study subjects.They were divided into standard calorie group,test group A and test group B according to a random number table,42 cases for each group.Patients started early nutritional support within 24 to 48 h of admission.After 7 days,the caloric intake increased to 30 kcal/(kg·d)in the standard calorie group,15 kcal/(kg·d)in test group A,and 9 kcal/(kg·d)in test group B.Nutrition-related parameters(albumin,prealbumin,and nitrogen balance),acute gastrointestinal injury(AGI)grade,sequen-tial organ failure assessment(SOFA)score,complications,and clinical outcomes were compared between the groups.Results After treatment,the nutritional indexes of test group A and test group B were higher than those of standard calorie group(P＜0.05),and the nutritional indexes of test group A were higher than those of the test group B(P＜0.05).The AGI grade score and SOFA score of test group A and test group B were lower than those of the standard calorie group(P＜0.05),and the AGI score and SOFA score of test group A were lower than those of test group B(P＜0.05).The incidence of each complication in test group A was less than that in the standard calorie group and test group B(P＜0.05).The mortality after 2 and 4 weeks of treatment in group A and 4 weeks of treatment in group B were lower than those in the standard calorie group(P＜0.05),and the mortality after 2 and 4 weeks of treatment in group A was lower than that in group B(P＜0.05).Conclusion Allowing low calorie nutrition support has important clinical significance for elderly critically ill patients.Adopting 15 kcal/(kg·d)calorie level can improve the nutritional status of elderly critically ill patients,protect gastrointestinal function,and effectively control complications and mortality.
关键词
老年重症患者/允许性低热量/营养支持/急性胃肠道损伤分级/序贯性器官功能衰竭评分Key words
Elderly critically ill patients/Permissive hypocaloric/Nutritional support/Acute gastrointestinal injury clas-sification/Sepsis organ failure assessment score引用本文复制引用
出版年
2024
国家科技期刊平台
NSTL
维普
万方数据