摘要
目的 调查分析重症患者营养支持现状对其营养指标及临床结局的影响.方法 本研究为一项单中心回顾性队列研究,回顾性选取2022年1月至6月入住南京大学医学院附属鼓楼医院ICU病区且符合入组条件的患者为研究对象,探究重症患者营养支持状况对临床结局的影响.结果 共纳入126名重症患者(女性35例,男性91例),年龄为(63.93±18.78)岁.患者 SOFA评分和 APACHE-Ⅱ评分分别为(6.62±4.11)分、(20.92±7.51)分.91 例(72.2％)为高营养风险患者(NUTRIC评分≥6),35例(27.8％)为低营养风险患者(NUTRIC评分＜6),接受营养支持的患者有111例(88.1％).在接受肠内营养的86例患者中,有55例(64.0％)患者早期肠内营养支持开始时机≤入室48 h.在进行营养支持的111例患者中,23例(20.7％)患者能量和蛋白质同时达标时间≤入室72 h.高营养风险组患者的总住院时间更久(P＜0.05),早期肠内营养组患者的28 d死亡率更低(P＜0.01),蛋白质早期充足组患者入室7 d内人血白蛋白的变化值更大(P＜0.05).结论 所有ICU住院时间超过48h的患者,均推荐入室48 h内开展早期肠内营养支持,早期肠内营养支持可以降低其28 d死亡率;早期蛋白质或者能量是否充足可能对ICU住院患者临床结局没有影响.
Abstract
Objective To determine the impact of state of nutritional support on nutritional indicators and clinical outcomes in critically ill patients.Methods A single-center retrospective cohort study was conducted.Patients admitted to the ICU of Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University from January to June 2022 who were eligible for enrollment were selected retrospectively.The impact of nutritional support status of critically ill patients on clinical outcome was determined.Results Totally 126 critically ill patients(35 females and 91 males)aged(63.93±18.78)years were included.The SOFA score and APACHE-Ⅱ score of patients were(6.62±4.11)and(20.92±7.51),respectively.Altogether 91(72.2％)patients were at high nutritional risk(NUTRIC score≥6)and 35(27.8％)patients were at low nutritional risk(NUTRIC score＜6).Totally 111(88.1％)patients received nutritional support.Of the 86 patients who received enteral nutrition,55(64.0％)received early enteral nutrition support at≤48 h of admission.Of the 111 patients who had nutritional support,23 patients(20.7％)showed both energy and protein compliance at≤72 h of admission.The total length of hospital stay was longer in the high-nutritional-risk group(P＜0.05),and the 28-day mortality rate in the early enteral nutrition group was lower(P＜0.01);the change in the serum albumin within 7 days of admission was greater(P＜0.05)for patients in the early protein adequacy group.Conclusion Early enteral nutritional support within 48 h of admission is recommended for patients with ICU stay longer than 48 h.Early enteral nutritional support reduces the 28-day mortality;early protein or energy adequacy has little effect on clinical outcome of patients in the ICU.
基金项目
国家自然科学基金(82002082)
南京大学中国医院改革发展研究院项目(NDYG202205l)
NETL
NSTL
万方数据