摘要
目的了解国内ICU收治患者的营养治疗实施状况。方法对国内116家医院的118个ICU内的患者进行营养治疗实施状况的横断面调查。以2017年4月26日0时所有在ICU内治疗的患者为调查对象,收集患者基本信息、2017年4月25日(即调查日)的营养实施和胃肠道耐受情况,以及患者的28 d临床转归情况。结果调查共收集病例1953例,女631例(32.4%),男1306例(66.9%),缺失16例(0.7%);年龄(64.1±19.3)岁(1950例)。患者GCS、SOFA和APACHEⅡ评分分别为(10.76±4.35)分(1749例)、(5.65±3.52)分(1783例)、(17.14±7.31)分(1792例)。28 d临床转归存活1483例(75.9%),死亡312例(16.0%),失访+缺失158例(8.1%)。除身高和体重(P=0.000)外,男性与女性患者在年龄、病情严重程度及28 d临床转归等方面差异均无统计学意义。1953例患者中,胃肠功能评估为正常或轻度损害占73.7%(1440例),中-重度损害占10.8%(210例),衰竭占1.7%(33例),13.2%(258例)的患者未做评估。截至调查日,69.4%(1356例)的患者已启动肠内营养(EN),36.4%(711例)的患者已启动肠外营养(PN)。调查日有营养摄入的患者1720例(88.1%)。1953例患者中明确有恶心、呕吐反流、误吸、腹痛、腹胀、腹泻(大便次数≥3次/d且量≥500 ml/d)等胃肠道不耐受表现的分别占总人数的4.8%(93例)、5.4%(105例)、0.9%(17例)、8.7%(170例)、27.5%(538例)和4.3%(84例)。在1270例使用EN的病例中,明确存在恶心、呕吐反流、误吸、腹痛、腹胀、腹泻等不耐受症状的分别占3.2%(40例)、4.3%(54例)、0.8%(10例)、4.4%(56例)、26.9%(341例)和5.4%(69例)。入ICU后24 h内开始EN治疗的患者占22.4%(437/1953),48 h内开始的占38.6%(754/1953),72 h内开始的占46.6%(911/1953)。患者入ICU后3 d总热卡(EN+PN非蛋白热卡)达标率为12.9%(78/607),7 d总热卡达标率为18.7%(189/1010),14 d总热卡的达标率为23.0%(305/1325)。入ICU后3、7、14 dEN达标率分别为9.9%(60/607)、15.0%(151/1010)和18.6%(246/1325)。结论目前我国ICU内的绝大多数患者均接受了营养治疗,其中EN的使用率明显高于PN;但EN的开始时间和达标情况仍不理想,且实施营养治疗时未能体现个体化差异,营养治疗的细节仍需要提高。
Objective To investigate nutritional treatment in the intensive care unit(ICU) of the China's Mainland.Methods A cross-sectional study was conducted in 116 ICUs of 118 mainland hospitals on April 26 th, 2017. All patients of these ICUs were investigated at 0 o’clock on April 26 th. Demographic and clinical parameters of those patients on April 25 th(the investigation day) were recorded, including the dates of hospitalization, ICU admission and nutrition initiation and clinical outcome on 28 days after the investigation day. Results A total of 1953 patients were collected, including 631 females and 1306 males. The mean age was(64.1±19.3) years old(1950 cases). The means of Glasgow Coma Scale(GCS), Sequential Organ Failure Assessment(SOFA) and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) scores were(10.76±4.35)(1749 cases),(5.65±3.52)(1783 cases),(17.14±7.31)(1792 cases), respectively. The outcomes of 28 days after the investigation day were 1483 survivors(75.9%), 312 non-survivors(16.0%) and 158 cases(8.1%) being lost to follow-up. There were no significant differences between the males and the females in age, severity of disease and clinical outcomes of 28 days but in height and weight. There were73.7%(1440 cases) of patients with normal or mildly injured gastrointestinal function, 10.8%(210 cases) with moderately or severely injured function, 1.7%(33 cases) with gastrointestinal failure and 13.2%(258 cases) without evaluation. To the investigation day,enteral nutrition(EN) had been initiated in 69.4%(1356 cases) of patients and parenteral nutrition(PN) in 36.4%(711 cases) of patients. There were 1720(88.1%) patients with EN administration on the investigation day. The proportion of patients with nausea,vomit/regurgitation, aspiration, abdominal pain, abdominal distention and diarrhea was 4.8%(93 cases), 5.4%(105 cases), 0.9%(17 cases), 8.7%(170 cases), 27.5%(538 cases) and 4.3%(84 cases) respectively, while that of patients using EN was 3.1%(40 cases),4.25%(54 cases), 0.79%(10 cases), 4.41%(56 cases), 26.85%(341 cases) and 5.43%(69 cases) correspondingly. The proportion of cases starting EN within 24, 48 and 72 hours after ICU entry was 22.4%(437/1953), 38.6%(754/1953) and 46.6%(911/1953),respectively. The proportion of cases receiving ≥80% estimated energy target(=past body weight ×25 kcal/kg.d) within 3, 7 and14 days after ICU entry was 12.9%(78/607), 18.7%(189/1010) and 23%(305/1325) respectively, while that of cases with EN was 9.9%(60/607), 15.0%(151/1010) and 18.6%(246/1325) correspondingly. Conclusions Nowadays, most of patients in the mainland ICUs receive nutrition therapy and the EN usage rate is much higher than the PN rate. However, the time of EN initiation and the target-reaching rate of energy are suboptimal and an individualized plan of nutrition therapy is still missing. Details of energy delivery still need to be improved.
作者
邢娟
章仲恒
柯路
周晶
秦秉玉
梁宏开
陈晓梅
刘文明
刘忠民
艾宇航
王迪芬
王秋卉
周青山
张福森
钱克俭
蒋东坡
臧彬
黎毅敏
黄晓波
曲彦
谢颖光
许东琳
邹志强
郑祥德
刘建波
郭丰
梁亚风
孙强
高红梅
刘阳
常平
程爱斌
杨荣利
么改琦
孙昀
王晓蓉
张怡
熊旭明
于健
孙荣青
李志伟
袁世荧
宋云林
高培阳
刘海燕
张朝辉
吴允孚
马标
郭强
山峰
杨明施
李海玲
李圆菲
鲁卫华
王磊
钱传云
王智勇
林建东
张汝敏
万鹏
彭志勇
龚裕强
黄林喜
伍国宝
孙洁
邓义军
师东武
周立新
周发春
石秦东
郭晓东
刘雪燕
武卫东
孟祥忠
李连弟
陈炜炜
李树生
万献尧
曹志新
张安
古利明
陈炜
吴京兰
周丽华
张震环
翁以炳
封永顺
杨春丽
冯永健
赵素民
佟飞
郝东
韩辉
付宝才
巩传勇
李志平
胡琨琳
寇秋野
张晗
刘洁
樊楚明
周新
陈秀梅
孙俊丽
周学军
宋斌
孙诚
赵丽芸
董兴鲁
张琳琳
佟大为
潘志国
蔡常洁
王东浩
董英俊
龚园其
吴志松
孟新科
王平
李维勤
XING Juan;ZHANG Zhong-heng;KE Lu;ZHOU Jing;QIN Bing-yu;LIANG Hong-kai;CHEN Xiao-mei;LIU Wenming;LIU Zhong-min;AI Yu-hang;WANG Di-fen;WANG Qiu-hui;ZHOU Qing-shan;ZHANG Fu-sen;QIAN Kejian;JIANG Dong-po;ZANG Bin;LI Yi-min;HUANG Xiao-bo;QU Yan;XIE Ying-guang;XU Dong-lin;ZOU Zhiqiang;ZHENG Xiang-de;LIU Jian-bo;GUO Feng;LIANG Ya-feng;SUN Qiang;GAO Hong-mei;LIU Yang;CHANG Ping;CHENG Ai-bin;YANG Rong-li;YAO Gai-qi;SUN Yun;WANG Xiao-rong;ZHANG Yi;XIONG Xu-ming;YU Jian;SUN Rong-qing;LI Zhi-wei;YUAN Shi-ying;SONG Yun-lin;GAO Pei-yang;LIU Hai-yan;ZHANG Zhao-hui;WU Yun-fu;MA Biao;GUO Qiang;SHAN Feng;YANG Ming-shi;LI Hai-ling;LI Yuan-fei;LU Wei-hua;WANG Lei;QIAN Chuan-yun;WANG Zhi-yong;LIN Jian-dong;ZHANG Ru-min;WAN Peng;PENG Zhi-yong;GONG Yu-qiang;HUANG Lin-xi;WU Guo-bao;SUN Jie;DENG Yi-jun;SHI Dong-wu;ZHOU Li-xin;ZHOU Fa-chun;SHI Qin-dong;GUO Xiao-dong;LIU Xue-yan;WU Wei-dong;MENG Xiang-zhong;LI Lian-di;CHEN Wei-wei;LI Shu-sheng;WAN Xian-yao;CAO Zhi-xin;ZHANG An;GU Li-ming;CHEN Wei;WU Jing-lan;ZHOU Li-hua;ZHANG Zhen-huan;WENG Yi-bing;FENG Yong-shun;YANG Chun-li;FENG Yong-jian;ZHAO Su-min;TONG Fei;HAO Dong;HAN Hui;Fu Bao-cai;GONG Chuan-yong;LI Zhi-ping;HU Kun-lin;KOU Qiu-ye;ZHANG Han;LIU Jie;FAN Chu-ming;ZHOU Xin;CHEN Xiu-mei;SUN Jun-li;ZHOU Xue-jun;SONG Bin;SUN Cheng;ZHAO Li-yun;DONG Xing-lu;ZHANG Lin-lin;TONG Da-wei;PAN Zhi-guo;CAI Chang-jie;WANG Dong-hao;DONG Ying-jun;GONG Yuan-qi;Wu Zhi-song;MENG Xin-ke;WANG Ping;LI Wei-qin
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2019年第5期388-393,共6页
Medical Journal of Chinese People's Liberation Army
基金
社会发展--重点病种规范化诊疗项目(BE2015685)~~
关键词
横断面研究
肠内营养
重症监护病房
胃肠道耐受性
营养达标率
cross-sectional study
enteral nutrition
intensive care unit
gastrointestinal tolerance
standard-reaching rate of nutrition
