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中华重症医学电子杂志 ›› 2022, Vol. 08 ›› Issue (04) : 291 -294. doi: 10.3877/cma.j.issn.2096-1537.2022.04.002

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监测与评估是实现理想营养治疗的基石
许媛1,()   
  1. 1. 102218 北京,清华大学临床医学院 清华大学附属北京清华长庚医院重症医学科
  • 收稿日期:2022-10-30 出版日期:2022-11-28
  • 通信作者: 许媛

Monitoring and assessment lead to optimal nutritional therapy

Yuan Xu1,()   

  1. 1. Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
  • Received:2022-10-30 Published:2022-11-28
  • Corresponding author: Yuan Xu
引用本文:

许媛. 监测与评估是实现理想营养治疗的基石[J]. 中华重症医学电子杂志, 2022, 08(04): 291-294.

Yuan Xu. Monitoring and assessment lead to optimal nutritional therapy[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2022, 08(04): 291-294.

近年来危重症患者的营养治疗得到了不断发展,但是为每位患者提供最佳的营养治疗仍在继续。营养监测和评估对于认识和理解危重症患者营养治疗面临的异质性挑战非常重要。可测量的反映患者的生物过程、致病状态或对营养干预的代谢反应的指标将是实现最佳营养目标的保证。指导个体化营养治疗更重要的是了解营养、胃肠道和危重症之间的病理生理变化的相互作用。本文围绕危重症营养评估与营养治疗监测进行重点讨论,同时讨论营养监测在重症患者治疗中的可行性和价值。

While nutrition therapy in critically ill patients has been improved in decades, continuous efforts to reach optimal nutrition therapy for each individual patient are still being made. Nutritional monitoring and assessment are important to analyze and understand the challenges of heterogeneity in critical ill patients. Measurable indicators of biological processes, pathogenic states, or metabolic responding to nutritional interventions can guarantee the achievement of optimal nutrition goal. More effective guidance to individualized nutrition therapy is to understand the interplay of pathophysiologic changes between nutrition, gastrointestinal tract, and critical illness. This article focuses on nutrition monitoring in critical ill patients during nutrition therapy and some nutritional biomarkers, and also discusses the feasibility and availability in the critical care setting.

17
Gunst J, De Bruyn A, Van den Berghe G. Glucose control in the ICU [J]. Curr Opin Anaesthesiol, 2019, 32(2): 156-162.
18
Leelarathna L, English SW, Thabit H, et al. Feasibility of fully automated closed-loop glucose control using continuous subcutaneous glucose measurements in critical illness: a randomized controlled trial [J]. Crit Care, 2013, 17(4): R159.
19
Reignier J, Mercier E, Le Gouge A, et al. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial [J]. J Am Med Assoc, 2013, 309: 249-256.
20
Hamada SR, Garcon P, Ronot M, et al. Ultrasound assessment of gastric volume in critically ill patients [J]. Intensive Care Med, 2014, 40: 965-972
21
邹同娟, 冉启芳, 尹万红, 等. 床旁超声测量胃窦横截面积对重症患者喂养不耐受的预测价值 [J]. 四川大学学报(医学版), 2019, 50(6): 815-820.
22
Sharma K, Mogensen KM, Robinson MK. Pathophysiology of critical illness and role of nutrition [J]. Nutr Clin Pract, 2019, 34(1): 12-22.
1
Yébenes JC, Campins L, Martínez de Lagran I, et al; Working Group on Nutrition and Metabolism of the Spanish Society of Critical Care. Nutritrauma: a key concept for minimising the harmful effects of the administration of medical nutrition therapy [J]. Nutrients, 2019, 11(8): 1775.
2
de Vries MC, Koekkoek WK, Opdam MH, et al. Nutritional assessment of critically ill patients: validation of the modified NUTRIC score [J]. Eur J Clin Nutr, 2018, 72(3): 428-435.
3
Majari K, Imani H, Hosseini S, et al. Comparison of modified NUTRIC, NRS-2002, and MUST scores in Iranian critically ill patients admitted to intensive care units: a prospective cohort study [J]. JPEN J Parenter Enteral Nutr, 2021, 45(7): 1504-1513.
4
Zusman O, Theilla M, Cohen J, et al. Resting energy expenditure, calorie and protein consumption in critically ill patients: a retrospective cohort study [J]. Crit Care, 2016, 20(1): 367.
5
Segadilha NLAL, Rocha EEM, Tanaka LMS, et al. Energy expenditure in critically ill elderly patients: indirect calorimetry vs predictive equations [J]. JPEN, 2017, 41(5): 776-784.
6
Moonen HPFX, Beckers KJH, van Zanten ARH. Energy expenditure and indirect calorimetry in critical illness and convalescence: current evidence and practical considerations [J]. J Intensive Care, 2021, 9(1): 8.
7
Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit [J]. Clin Nutr, 2019, 38(1): 48-79.
8
Taylor BE, McClave SA, Martindale RG, et al; Society of Critical Care Medicine; American Society of Parenteral and Enteral Nutrition. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) [J]. Crit Care Med, 2016, 44(2): 390-438.
9
Fraipont V, Preiser JC. Energy estimation and measurement in critically ill patients [J]. JPEN J Parenter Enteral Nutr, 2013, 37(6): 705-713.
10
Stapel SN, Weijs PJM, Girbes ARJ, et al. Indirect calorimetry in critically ill mechanically ventilated patients: Comparison of E-sCOVX with the deltatrac [J]. Clin Nutr, 2019, 38(5): 2155-2160.
11
Ranasinghe RN, Biswas M, Vincent RP. Prealbumin: the clinical utility and analytical methodologies [J]. Ann Clin Biochem, 2022, 59(1): 7-14.
12
Beck FK, Rosenthal TC. Prealbumin: a marker for nutritional evaluation [J]. Am Fam Physician, 2002, 65(8): 1575-1578.
13
Page A, Flower L, Prowle J, et al. Novel methods to identify and measure catabolism [J]. Curr Opin Crit Care, 2021, 27(4): 361-366.
14
Kim TJ, Park SH, Jeong HB, et al. Optimizing nitrogen balance is associated with better outcomes in neurocritically ill patients [J]. Nutrients, 2020, 12(10): 3137.
15
Preiser JC, van Zanten AR, Berger MM, et al. Metabolic and nutritional support of critically ill patients: consensus and controversies [J]. Crit Care, 2015, 19(1): 35.
16
KrinsleyJames S, PreiserJean-Charles. Time in blood glucose range 70 to 140 mg/dl >80% is strongly associated with increased survival in non-diabetic critically ill adults [J]. Crit Care, 2015, 19: 179.
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