容许性低热量喂养对重症监护病房重症肺炎患者营养状态和预后的影响  

Impact of permissive low-calorie feeding on nutritional status and prognosis in intensive care unit patients with severe pneumonia

作　　者：张乐[1] 刘寒秋[1] 张玉萍[1] ZHANG Le;LIU Hanqiu;ZHANG Yuping(Department of Respiratory and Critical Care Medicine,Jiangsu Provincial People′s Hospital,Nanjing,Jiangsu,210029)

机构地区：[1]江苏省人民医院呼吸与危重症医学科监护病区,江苏南京210029

出　　处：《实用临床医药杂志》2025年第3期94-98,共5页Journal of Clinical Medicine in Practice

基　　金：2022年度江苏省老年健康科研项目(LKM2022002)。

摘　　要：目的探讨容许性低热量喂养对重症监护病房(ICU)重症肺炎患者营养状态和预后情况的影响。方法选取ICU重症肺炎患者100例,采用随机数字表法分为低热量喂养组和足量喂养组,每组50例。低热量喂养组采用容许性低热量喂养,足量喂养组采用足量喂养,疗程均为1周。比较2组患者的临床指标;比较2组患者治疗前和治疗1周后的营养指标、炎症指标、呼吸功能指标和肠黏膜屏障功能指标;比较2组患者的医院获得性肺炎(HAP)发生率和并发症发生情况(包括感染性休克、肺水肿、支气管扩张等)。结果低热量喂养组患者的退热时间、机械通气时间、ICU住院时间均短于足量喂养组,差异有统计学意义(P<0.05)。2组患者的28 d内病死率比较,差异无统计学意义(P>0.05)。治疗后,低热量喂养组患者的血清总蛋白(TP)、前白蛋白(PA)、血红蛋白(HGB)、白蛋白(ALB)水平与足量喂养组比较,差异无统计学意义(P>0.05);低热量喂养组降钙素原(PCT)和血清超敏反应C反应蛋白(hs-CRP)水平均低于足量喂养组,差异有统计学意义(P<0.05);低热量喂养组患者氧合指数、通气量、平均动脉压和中心动脉压均较足量喂养组低,差异有统计学意义(P<0.05);低热量喂养组D-乳酸和二胺氧化酶(DAO)水平较足量喂养组低,差异有统计学意义(P<0.05)。低热量喂养组HAP发生率和并发症发生率分别为4.00%和10.00%,足量喂养组分别为14.00%和18.00%,差异无统计学意义(P>0.05)。结论容许性低热量喂养对ICU重症肺炎患者的早期恢复有积极作用,可以较好地改善患者呼吸功能和肠黏膜屏障功能,降低其炎症指标水平。Objective To investigate the impact of permissive low-calorie feeding on nutritional status and prognosis in patients with severe pneumonia in the intensive care unit(ICU).Methods A total of 100 patients with severe pneumonia in ICU were selected and divided into low-calorie feeding group and adequate feeding group using a random number table method,with 50 patients in each group.The low-calorie feeding group received permissive low-calorie feeding,and the adequate feeding group received adequate feeding,both conducting for a duration of one week.Clinical indicators,nutritional indicators,inflammatory indicators,respiratory function indicators,and intestinal mucosal barrier function indicators were compared between the two groups before treatment and one week after treatment.The incidence of hospital-acquired pneumonia(HAP)and complications(including septic shock,pulmonary edema,bronchiectasis,etc.)were also compared between the two groups.Results The fever clearance time,mechanical ventilation time,and ICU stay duration were shorter in the low-calorie feeding group compared to the adequate feeding group(P<0.05).There was no statistically significant difference in 28-day mortality between the two groups(P>0.05).After treatment,there were no statistically significant differences in serum total protein(TP),prealbumin(PA),hemoglobin(HGB),and albumin(ALB)levels between the low-calorie feeding group and the adequate feeding group(P>0.05).The levels of procalcitonin(PCT)and high-sensitivity C-reactive protein(hs-CRP)were lower in the low-calorie feeding group compared to the adequate feeding group(P<0.05).The oxygenation index,ventilation volume,mean arterial pressure,and central arterial pressure were lower in the low-calorie feeding group compared to the adequate feeding group(P<0.05).The levels of D-lactic acid and diamine oxidase(DAO)were also lower in the low-calorie feeding group compared to the adequate feeding group(P<0.05).The incidence of HAP and complications was 4.00%and 10.00%in the low-calorie feeding gro

关 键 词：容许性低热量喂养 重症监护病房 重症肺炎 住院 营养状态 

分 类 号：R459.3[医药卫生—治疗学] R563.1[医药卫生—临床医学] R473.5