限制热卡营养在ICU内科重症成年患者中的早期应用  

Clinical study on underfeeding and standard enteral feeding for medical patients in ICU

作　　者：张静[1] 刘晓姝[1] 郭璐[2] 滕鸿[1] 解郑良[1] 杨阳[1] 

机构地区：[1]四川省医学科学院四川省人民医院内科ICU,四川成都610072 [2]四川省医学科学院四川省人民医院呼吸内科,四川成都610072

出　　处：《中国急救医学》2017年第5期450-453,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨限制热卡营养在重症监护病房（ICU）内科重症成年患者中的早期应用价值。方法收集2015—05～2016—03我院ICU内科重症成年患者183例，随机分为限制热卡饮食（理论热卡需要量的40％～60％）组（n=92）和足量热卡营养（理论热卡需要量的70％-100％）组（n=91），两组均观察至14d，同时两组患者均提供相近似的蛋白质摄入量。主要观察终点为28d病死率。结果两组基线情况相似，在研究干预期间，限制热卡组接受的热量较足量热卡组少[（819±289）kcal／dvs．（1280±436）kcal／d，P〈0．05]，实际摄入热卡占标准需要热卡比例[（47±13）％vs．（73±21）％，P〈0.05]。两组间蛋白质摄入量基本相似[限制热卡组（47±16）g／d，足量热卡组（48±22）g／d；P=0．29]。28d病死率相近。限制热卡组患者中死亡19例，足量热卡组死亡18例（18．9％vs．19．7％，RR0．95，95％C10．67～1．19，P=0．70）。两组均无严重不良反应，在饮食耐受性和ICU中的感染率、1CU或住院时间上差异均无统计学意义（P〉0．05）。结论内科重症成年患者在提供充足蛋白质时，限制热卡营养与足量热卡营养方式比较，并不增加病死率。Objective It＇s unclear that the appropriate caloric goal for the internal patients in intensive care unit（ICU）. We evaluated the effect of restriction of calories , as compared with standard enteral feeding, on 28 - day mortality among internal medicine adults in ICU, at the same time provided the full recommended amount of protein in both groups. Methods We randomly assigned 183 critically medical ill adults to underfeeding （40% to 60% of calculated caloric requirements） or standard enteral feeding （70% to 100% ） for up to 14 days,with maintaining a similar protein intake in both groups. The primary outcome was 28 - day mortality. Results Baseline characteristics were similar in the two groups ; 88.0% of the patients were receiving mechanical ventilation. During the intervention period, the underfeeding group received fewer mean calories than did the standard feeding group [ （819 ± 289） keal per day vs. （1280 ±436） kcal per day, P 〈0.051; [（47 ± 13）% vs. （73 ±21）% of calorie requirements, P 〈0.05 ]. Protein intake was similar in the two groups [ （47 ± 16）g per day and （48 ± 22）g per day, P = 0. 291. The 28 - day mortality was similar： 19 of 92 patients （ 18.9% ） in the underfeeding group and 18 of 91 patients （ 19.7% ） in the standard - feeding group died[ relative risk （HH） with undeffeeding,0. 95; 95% CI 0.67 to 1. 19; P = 0.7 ]. No serious adverse events were reported; there were no significant differences between the to groups with respect to feeding intolerance,diarrhea, and infections acquired in the ICU, or ICU or hospital length of stay. Conclusion With enteral feeding to deliver a moderate amount of nonprotein calories to critically ill adults, underfeeding is not associated with higher mortality than standard feeding.

关 键 词：限制热卡营养 足量热卡营养 重症监护病房(ICU) 病死率 

分 类 号：R473.73[医药卫生—护理学]