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危重病患者接受高能量密度和常规肠内营养支持的比较
Energy-Dense versus Routine Enteral Nutrition in the Critically Ill


The TARGET Investigators ... 其他 • 2018.11.08
相关阅读
• 能量密集肠内营养对危重病患者无益

ICU重症患者肠内营养高能量密度还是常规配方更利于患者生存

 

张琳琳

首都医科大学附属北京天坛医院重症医学科

 

危重患者的营养治疗一直是困扰重症医学科医师的难题之一。营养治疗包括肠内营养和肠外营养,2018年9月发布的欧洲临床营养和代谢学会(ESPEN)《ICU临床营养指南》认为入住ICU超过48小时的患者应考虑接受营养治疗。由于早期肠内营养相比肠外营养已被证实可显著降低感染的概率,故而首选肠内营养;对于不能肠内营养的患者也要进行肠外营养。

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摘要


背景

在危重病期间给予不同热量水平营养支持的效果尚不确定,并且患者通常接受的量低于推荐量。

 

方法

我们在澳大利亚和新西兰46个重症监护治疗病房(ICU)中对接受机械通气的成人患者开展了一项多中心、双盲、随机试验,以评估高能量密度(1.5 kcal/mL)肠内营养支持,并与常规(1.0 kcal/mL)肠内营养支持进行比较,使用的剂量为每小时1 mL/kg理想体重,在营养支持开始时或12小时内开始使用,并在患者住在ICU期间持续长达28日。主要结局为90日内的全因死亡率。

 

结果

3,957例患者被纳入改良意向治疗分析中(1.5 kcal组1,971例和1.0 kcal组1,986例)。在本试验期间,两组给予的肠内营养量相似;然而,1.5 kcal组和1.0 kcal组患者摄入的热量平均值(±SD)分别为1,863 kcal/d±478 kcal/d和1,262 kcal/d±313 kcal/d(平均差,601 kcal/d;95%置信区间[CI],576~626)。截至第90日,共有1.5 kcal组1,948例患者中的523例(26.8%)和1.0 kcal组1,966例患者中的505例(25.7%)死亡(相对危险度,1.05;95% CI,0.94~1.16;P=0.41)。七个预设亚组的结果相似。给予较高热量未影响生存时间、接受器官支持的情况、在ICU外和院外或无器官支持情况下的生存天数或者感染性并发症或不良事件的发生率。

 

结论

在接受机械通气的患者中,使用高能量密度肠内营养制剂患者的90日生存率不高于使用常规肠内营养制剂的患者(由澳大利亚国立健康与医学研究所[National Health and Medical Research Institute of Australia]和新西兰健康研究委员会[Health Research Council of New Zealand]资助;TARGET在ClinicalTrials.gov注册号为NCT02306746)。





作者信息

The TARGET Investigators, for the ANZICS Clinical Trials Group*
Address reprint requests to Dr. Peake at the Department of Intensive Care Medicine, Queen Elizabeth Hospital, 28 Woodville Rd., Woodville South SA 5011, Australia, or at sandra.peake@sa.gov.au. The Augmented versus Routine Approach to Giving Energy Trial (TARGET) is a collaboration of the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group and the Australian and New Zealand Intensive Care Research Centre. A complete list of committee members, affiliations, participating sites, and investigators in the TARGET trial is provided in the Supplementary Appendix, available at NEJM.org. *The members of the writing committee (Marianne Chapman, M.D., Ph.D., Sandra L. Peake, M.D., Ph.D., Rinaldo Bellomo, M.D., Ph.D., Andrew Davies, M.D., Adam Deane, M.D., Ph.D., Michael Horowitz, M.D., Ph.D., Sally Hurford, R.N., Kylie Lange, B.Sc., Lorraine Little, M.Bioethics, Diane Mackle, M.N., Stephanie O’Connor, M.N.Sc., Jeffrey Presneill, M.D., Ph.D., Emma Ridley, B.Nut.Dietet., Ph.D., Patricia Williams, B.N.P., and Paul Young, M.D., Ph.D.) assume responsibility for the overall content and integrity of this article. The affiliations of the members of the writing committee are listed in the Appendix.

 

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