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中华重症医学电子杂志 ›› 2022, Vol. 08 ›› Issue (04) : 326 -332. doi: 10.3877/cma.j.issn.2096-1537.2022.04.009

专题笔谈

重症患者个体化营养治疗及相关监测
姚晏1, 黄惠斌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:2022-10-17 出版日期:2022-11-28
  • 通信作者: 黄惠斌
  • 基金资助:
    吴阶平医学基金会临床科研专项资助基金(320.6750.2022-02-18)

Advances in individualized nutritional therapy and related monitoring in critically ill patients

Yan Yao1, Huibin Huang1,()   

  1. 1. Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
  • Received:2022-10-17 Published:2022-11-28
  • Corresponding author: Huibin Huang
引用本文:

姚晏, 黄惠斌. 重症患者个体化营养治疗及相关监测[J]. 中华重症医学电子杂志, 2022, 08(04): 326-332.

Yan Yao, Huibin Huang. Advances in individualized nutritional therapy and related monitoring in critically ill patients[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2022, 08(04): 326-332.

ICU患者是高异质性的群体,需要个性化的营养支持。本综述回顾了重症患者个体化营养治疗的最新进展。ICU患者接受营养治疗之前,需要进行营养风险筛查和营养评估,以确定患者能否从营养治疗中获益,并评估他们对营养的耐受能力。临床常用的预测公式在预测重症患者的静息能量消耗上是不准确的。相比之下,间接量热法指导的能量供给策略能显著改善ICU患者的生存率,并得到指南强烈推荐。高蛋白供应策略不能改善患者的预后,而改善的氮平衡(NB)与降低危重患者的全因病死率有关。由此强调了在营养治疗期间动态监测NB的要求。此外,治疗期间应监测再喂养综合征和个体喂养耐受性。总之,有必要在营养治疗全过程中进行个体化、评估、监测和调整。未来需要精心设计的随机对照试验(RCT)来评价重症患者的个体化营养治疗。

ICU patients are a highly heterogeneous group, necessitating individualized nutritional support. This review examined recent advances in individualized nutritional therapy for critically ill patients. Before nutritional treatment, nutritional risk screening and nutritional assessment are required to determine whether individual ICU patients can benefit from nutritional therapy and assess their ability to tolerate nutrition. Equations are inaccurate in predicting resting energy expenditure in critically ill patients. In contrast, indirect calorimetry-guided energy delivery significantly improved survival in ICU patients and is strongly recommended by guidelines. High-protein supply strategies do not improve patients' prognoses, while improved nitrogen balance is associated with reduced all-cause mortality in critically ill patients. This emphasizes the requirement for dynamic monitoring of nitrogen balance during nutritional therapy. Additionally, nutritional treatment requires attention to refeeding syndrome and feeding tolerance monitoring. In summary, nutritional therapy must be individualized, evaluated, monitored, and adjusted throughout treatment. Furthermore, well-designed RCTs on individualized nutritional therapy in critically ill patients are required.

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