合理营养可能让你早日出院回家：热卡/蛋白质缺乏对外科重症患者出院后去向的影响

2015年度美国肠外肠内营养学会（ASPEN）最有前途研究者奖（2015 Promising Investigator Award）得主

麻省总医院（马萨诸塞综合医院）

　　背景：外科重症监护病房（ICU）宏量营养素缺乏与住院期间不良结局相关。我们猜测热卡/蛋白质不足的增多与出院后回家可能性降低而出院后转入康复设施或护理院可能性增加相关。

　　资料与方法：本研究纳入了2012年3月～2014年5月成人外科ICU内接受肠内营养（EN）＞72h的患者。排除存在EN绝对禁忌证患者、在ICU＜72h患者、濒死患者、进入外科ICU之前就进行EN的患者或住院期间先前在ICU治疗过的患者。按照累积热卡（＜6000比≥6000kcal）和蛋白质缺乏（＜300比≥300g）将研究对象分为两组。通过秩和检验和χ²检验对两组的基线特征和结局进行比较。为了检验宏量营养素缺乏和出院终点（回家比其他）的相关性，我们进行了逻辑斯谛回归分析，控制了表面合理的混杂因素。

　　结果：共纳入了213名患者。低热卡缺乏组的19%出院回家，而高热卡缺乏组仅有6%出院回家（P=0.02）。两组的年龄，体重指数（BMI），急性生理和慢性健康评估Ⅱ（APACHEⅡ）以及EN情况的差异无统计学意义。在逻辑斯谛回归分析中，调整了BMI和APACHEⅡ评分，高热卡和蛋白质缺乏组出院回家的机率较小（比值比[OR]：0.28，95%可信区间[CI]：0.08～0.96，P=0.04；OR：0.29，95% CI：0.0～0.89，P=0.03）。

　　结论：在外科ICU患者中，宏量营养素补充不足与出院回家机率降低有关。改善营养补充有助于改善重症后期的临床结局。

JPEN J Parenter Enteral Nutr. 2016;40(1):37-44.

Adequate Nutrition May Get You Home: Effect of Caloric/Protein Deficits on the Discharge Destination of Critically Ill Surgical Patients.

Yeh DD, Fuentes E, Quraishi SA, Cropano C, Kaafarani H, Lee J, King DR, DeMoya M, Fagenholz P, Butler K, Chang Y, Velmahos G.

Massachusetts General Hospital, Boston, Massachusetts.

BACKGROUND: Macronutrient deficit in the surgical intensive care unit (ICU) is associated with worse in-hospital outcomes. We hypothesized that increased caloric and protein deficit is also associated with a lower likelihood of discharge to home vs transfer to a rehabilitation or skilled nursing facility.

MATERIALS AND METHODS: Adult surgical ICU patients receiving >72 hours of enteral nutrition (EN) between March 2012 and May 2014 were included. Patients with absolute contraindications to EN, <72-hour ICU stay, moribund state, EN prior to surgical ICU admission, or previous ICU admission within the same hospital stay were excluded. Subjects were dichotomized by cumulative caloric (<6000 vs ≥6000 kcal) and protein deficit (<300 vs ≥300 g). Baseline characteristics and outcomes were compared using Wilcoxon rank and χ(2) tests. To test the association of macronutrient deficit with discharge destination (home vs other), we performed a logistic regression analysis, controlling for plausible confounders.

RESULTS: In total, 213 individuals were included. Nineteen percent in the low-caloric deficit group were discharged home compared with 6% in the high-caloric deficit group (P = .02). Age, body mass index (BMI), Acute Physiology and Chronic Health Evaluation II (APACHE II), and initiation of EN were not significantly different between groups. On logistic regression, adjusting for BMI and APACHE II score, the high-caloric and protein-deficit groups were less likely to be discharged home (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.08-0.96; P = .04 and OR, 0.29; 95% CI, 0.0-0.89, P = .03, respectively).

CONCLUSIONS: In surgical ICU patients, inadequate macronutrient delivery is associated with lower rates of discharge to home. Improved nutrition delivery may lead to better clinical outcomes after critical illness.

KEYWORDS: adult; critical care; enteral nutrition; life cycle; nutrition; proteins; rehabilitation; research and diseases

PMID: 25926426

DOI: 10.1177/0148607115585142