早期高蛋白营养对重症病人住院后期肌力的影响  

The effects of early high-dose protein supplementation on later-stage muscle strength in critically ill patients

作　　者：肖燕[1] 朱子贵 陈嘉成 贺承健[1] XIAO Yan;ZHU Zi-gui;CHENG Jia-cheng;HE Cheng-jian(Department of Intensive Care Unit,Affiliated Nanhua Hospital,University of South China,Hengyang 421002,Hunan,China)

机构地区：[1]南华大学附属南华医院重症医学科,湖南衡阳421002

出　　处：《肠外与肠内营养》2021年第2期100-103,共4页Parenteral & Enteral Nutrition

基　　金：湖南省衡阳市科技局2019年指导性计划项目(衡科发[2019]47号187)。

摘　　要：目的:本研究旨在观察ICU病人早期提供高蛋白营养方案,对病程后期病人肌力的影响。方法:前瞻性观察性研究,收集并分析2017年1月~2019年7月就诊于南华大学附属南华医院重症医学科的成年重症病人的临床数据,根据其蛋白营养方案的不同,分为强化蛋白治疗达标组[>1.2g/(kg·d()研究组)]和强化蛋白治疗非达标组[<1.2 g/(kg·d)(对照组)]。统计并分析病人的基线情况,入院治疗与干预情况,营养治疗情况,临床预后,住院后期肌力情况等相关指标。结果:两组病人在基线情况、入院干预治疗等方面没有显著差异,研究组病人平均每日蛋白供给量要显著高于对照组(P<0.001)。在主要临床预后指标方面,两组间在机械通气时间,院内死亡率,ICU住院时间以及总住院时间等方面没有差异。以MRC总分<48分作为ICU获得性虚弱(ICU-AW)的初步诊断标准,入院后第21天和第28天,研究组病人ICU-AW的发生率要显著低于对照组(P<0.05)。Logistic回归分析结果显示高蛋白供给是ICU-AW发生的独立保护因素。结论:早期强化蛋白补充可显著改善重症病人住院后期的肌力情况,对重症病人的后期恢复有保护作用。Objective:This study aimed to investigate the effects of early high-dose protein supplementation on muscle strength in critically ill patients in late stage of diseases.Methods:A prospective observational study with adult critically ill patients admitted to our hospital from January 2017 to July 2019 was carried out.According to the different protein delivery amounts,patients were divided into two groups,the enhanced protein supplementation[>1.2 g/(kg·d)]group(the study group)and non-intensive nutrition therapy[<1.2 g/(kg·d)]group(the control group).The baseline data,admission treatment and interventions,nutritional treatments,main clinical outcomes,later-stage muscle strength and other related indicators were recorded and analysed.Results:There was no significant difference between the two groups in terms of baseline data and admission interventions.The average daily protein supply of the study group was significantly higher than that of the control group(P<0.001).There was no difference in the duration of mechanical ventilation,in-hospital mortality,length of ICU stay and length of hospital stay between the two groups.Taking the total score of MRC<48 as the primary diagnostic standard for ICU-acquired weakness(ICU-AW),the incidence of ICU-AW in the study group was significantly lower than that in the control group on the 21st and 28th days post admission(P<0.05).Logistic regression analysis showed that high-dose protein supply was an independent protective factor for the incidence of ICU-AW.Conclusions:Early high-dose protein supplementation could significantly improve the muscle strength of critically ill patients in the late stage of hospitalization,and has a protective effect on the recovery of critically ill patients.

关 键 词：重症病人 早期高蛋白 肌力 ICU获得性衰弱 

分 类 号：R605[医药卫生—外科学]