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我国危重症病人营养支持现状调查分析
An investigation on current practice of nutrition support for critically ill in Chinese ICU
【摘要】 目的:在全国范围内调查机械通气危重症病人EN和PN支持现状和存在问题,为进一步改进危重症病人营养支持策略提供临床依据。方法:国内多中心、前瞻性和观察性研究。本次调查历时100 d,共有15个省市、25所医院、26个ICU共443例病人参与。依据加拿大Heyland研究小组发起的2008年全球ICU危重症病人营养支持应用现状调查的内容,对所得结果进行独立统计学分析。结果:19个ICU(73%)对病人EN期间床头抬高、胃残余量监测、中止喂养或转为小肠喂养指征等具体实施细则有明确的规定。25个ICU(96.2%)有计划应用胰岛素控制病人血糖。早期(入住ICU48 h内)TEN病人仅占38.8%(172/443);EN+PN占20.5%(91/443);因不耐受EN而中途中止的病人共10例(5.8%)。本次调查共观察4 303 d。2 003 d(46.5%)接受TEN,869 d接受EN+PN(20.2%)。72 h内达到80%预计能量病人共82例(47.7%),与未达预计能量病人相比,机械通气时间、入住ICU时间、住院时间和病死率均无显著性差异。接受PN病人共230例,经PN液中添加Gln者占38.3%(88/230);机械通气时间(P=0.001)和入住ICU时间(P=0.005)明显少于未添加Gln组。结论:危重症病人营养支持已得到广泛认可和重视,并通过具体的实施方案规范临床行为。EN仍存在喂养不足和累积能量摄入的缺乏。PN液中添加Gln能缩短病人机械通气和入住ICU的时间。
【Abstract】 Objective and methods: To conduct a nationwide multicenter survey to evaluate the current practice of nutrition support in Chinese ICU.Despite a simultaneous survey we performed as a part of the international project led by Dr.Heyland,this was an independent study in attempt to find problems and to help to improve the quality of nutrition therapy in ICU in China.Methods of the study were adapted from the Canada international nutrition survey study.Results: 443 mechanically ventilated patients from 26 ICUs of 25 hospitals were enrolled in this study in a period of 100 days in 2008.In 19 ICUs(73%),detailed instructions for enteral nutrition(EN) delivery were provided including maintaining the head-of-bed(HOB),monitoring gastric residual volumes(GRV),and the protocols for starting or stopping enteral feeding.Almost all ICUs(25,96%) have blood glucose control strategy during nutrition support.The patients having achieved early total enteral nutrition(<48 hrs) were 38.8%(172/443).The patients with EN and PN were 20.5%(91/443).Ten patients(5.8%) stopped their EN because of GI intolerance.There were totally 4303 observation days in this study,in which 2003 days were under TEN(46.5%) and 869 days were under PN+EN(20.2%),respectively.82 patients(47.7%) reached 80% of the goal for energy requirement.In comparison with the patients whom energy supplement was less than 80% of the goal at 72 hours,no significant difference was found in mechanical ventilation time,ICU days,length of stay in the hospital and the mortality.However,mechanical ventilation time(P=0.001) and ICU days(P=0.005) were decreased significantly in patients under parenteral nutrition plus intravenous glutamine supplying(38.3%,88/230).Conclusion: Nutrition support has been widely applied in Chinese ICUs.Underfeeding and negative cumulated energy balance were found in patients with enteral nutrition.The benefit on outcome was detected in patients with intravenous glutamine supplying during parenteral nutrition.
【Key words】 Nutritional support； Parenteral nutrition； Enteral nutrition； Critically ill；
- 【文献出处】 肠外与肠内营养 ,Parenteral & Enteral Nutrition , 编辑部邮箱 ,2009年05期
- 【分类号】R459.7
- 【被引频次】90
- 【下载频次】1548