重症AKI患者营养支持治疗中氮排量监测的意义

The significance of nitrogen excretion monitoring in nutritional therapy in ICU AKI patients

目的检索并获取合并急性肾损伤(AKI)的重症患者进行营养治疗时监测氮排量的相关临床证据,为临床实践提供参考意见。方法通过计算机完整地检索PubMed、Embase、Web of Science、Cochrane Library、中国知网、万方、维普等数据库,收集关于氮排量与进行营养治疗的AKI重症患者预后相关性的临床研究,包括系统评价/meta分析、随机对照试验(RCT)/非RCT、观察性研究(回顾性/前瞻性研究)、病例对照研究等,同时追索纳入文献的参考文献。文献检索起止时间为自建库至2022年8月,为保证研究质量,仅纳入2000年1月以后的文献。由两名研究者各自独立完成文献筛选及质量评价,并对文献能否支持最终结果做出判定。结果最终入选7项研究,共收集709例患者数据。包含2项RCT研究、1项前瞻干预研究及4项观察性研究。定性分析发现,持续的负氮平衡可能影响AKI患者的预后,肾功能损伤可能导致氮排量减低,而行肾脏替代治疗(RRT)可能增加额外的氮丢失,进行RRT的AKI患者增加氮摄入可以促进正氮平衡,改善患者预后。结论合并AKI的重症患者营养治疗时尤其需要关注氮平衡;监测氮平衡可以对营养治疗方案的制定提供参考。

Objective To retrieve and obtain clinical evidence of whether nitrogen excretion should be monitored in critically ill patients with acute kidney injury(AKI)during nutritional therapy,so as to provide evidence to clinical practice.Methods Available published data(2000.01—2022.08)was retrieved from PubMed,Embase,Web of science,Cochrane Collaboration,CNKI and Wan Fang Data with keywords related with nitrogen excretion in critically ill patients with AKI during nutritional treatment.Further search was performed to identify all available studies.Literature selection and quality assessment of all included studies were performed by two researchers independently.Results Seven studies with data for 709 patients were included showing that nitrogen balance could be interfered by renal dysfunction or renal replacement therapy,and negative nitrogen balance may have bad affect on critically ill patients with AKI.Conclusions we should pay special attention to nitrogen balance in those patients.Monitoring nitrogen excretion is useful to maintain nitrogen balance and provide evidence for nutritional therapy.