早期足够蛋白质摄入对危重病人预后的影响

Ying Xu, P. Liang, Y. Wen-kui, Zhanghua Zhu, L. Ning, Dan-jiang Dong, Jian-zhun Tang, Yong You, Yan Wang, Chen Ming, Yang Liu
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摘要

目的探讨早期和晚期蛋白质摄入对危重患者预后的影响。方法选取2016年9月至2018年3月我院重症监护病房收治的危重患者326例进行前瞻性观察研究。根据患者28天预后分为死亡组和生存组。早期蛋白质目标(EPT)定义为第1-3天每日蛋白质摄入量≥0.8 g/(kg·d),晚期蛋白质目标(LPT)定义为第4-7天每日蛋白质摄入量≥0.8 g/(k·d)。结果非存活组第1天和第3天的日蛋白质摄入量以及第1-3天的累积蛋白质摄入量显著高于存活组(P < 0.05)。住院死亡率以LPT组最低,EPT组最高,EPT+ LPT组和非EPT+非LPT组居中(P<0.05)。生存曲线分析显示,单药组的生存时间显著低于单药组(P<0.05)。多因素分析显示,年龄、性别、1-7天累积蛋白质和热量摄入是死亡率的独立危险因素。结论早期低蛋白质摄入有利于危重症患者的预后,并结合晚期充足的蛋白质摄入可进一步改善危重症患者的预后。关键词:危重病人;蛋白质的摄入;卡路里的摄入量;结果
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Effect of early enough protein intake on outcomes of critically ill patients
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). 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. Key words: Critically ill patients; Protein intake; Caloric intake; Outcome
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中华临床营养杂志
中华临床营养杂志 Nursing-Nutrition and Dietetics
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2282
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