危重患者能量和蛋白质摄入目标及计算方法最佳证据总结

Summary of the best evidence for the energy and protein intake targets and calculation in critically ill patients

目的:总结成人危重患者能量和蛋白质摄入目标及计算方法的最佳证据,为临床重症营养管理提供循证依据。方法:系统检索美国国立医学图书馆PubMed数据库、护理和辅助医学文献累积索引(CINAHL)、荷兰医学文摘Embase数据库、Cochrane图书馆数据库、UpToDate临床顾问、BMJ最佳临床实践、JBI循证卫生保健中心、科学网(Web of Science)、中国生物医学文献服务系统、中国医脉通、中国知网、万方、维普、国际指南协作网(GIN)、英国国家卫生与临床优化研究所指南库(NICE)、美国国立指南库(NGC)、加拿大安大略注册护士协会(RNAO)数据库、美国重症医学会(SCCM)数据库中与成人危重患者能量和蛋白质摄入目标及计算方法相关的证据,包括临床指南、专家共识、系统评价、证据总结,检索时间为2012年1月至2022年6月。由2名研究者采用JBI循证卫生保健中心评价工具和临床实践指南研究与评价系统Ⅱ(AGREEⅡ)量表分别对纳入的不同类型文献进行质量评价,提取并汇总成人危重患者营养摄入目标及计算方法的最佳证据,并进行证据描述。结果:共纳入18篇文献,其中临床指南5篇,专家共识8篇,系统评价3篇,证据总结2篇。经过文献质量评价,18篇文献均纳入。最终从能量目标计算方法、剂量体质量、能量摄入目标和蛋白质摄入目标及计算方法4个方面形成了24条最佳证据。结论:基于循证总结成人危重患者能量和蛋白质摄入目标及计算方法的最佳证据,临床医务人员可在有条件情况下选择间接测热法计算能量目标,准确获取患者身高、体质量数据并根据体质量指数(BMI)确定剂量体质量,根据使用的能量目标计算方法调整早期能量目标,同时应采用血尿素氮(BUN)损失、去脂体质量、简易公式等方法持续评估并调整蛋白质摄入目标,以达到最优化重症营养支持的目的。

Objective To evaluate and summarize the best evidence of energy and protein intake targets and calculation in adult critically ill patients,and to provide evidence-based basis for critical nutrition management.Methods Evidence related to energy and protein intake targets and calculation of adult critically ill patients,including guideline,expert consensus,systematic review and evidence summary,were systematically searched in PubMed,Cumulative Index to Nursing and Allied Health Literature(CINAHL),Embase,Cochrane Library,UpToDate,BMJ Best Practice,Joanna Briggs Institute(JBI),Web of Science,SinoMed,Medive,China National Knowledge Infrastructure,Wanfang database,VIP database,Guidelines International Network(GIN),National Institute for Health and Care Excellence(NICE),National Guideline Clearinghouse(NGC),Registered Nurses Association of Ontario(RNAO),and Society of Critical Care Medicine(SCCM)from January 2012 to June 2022.Two researchers independently evaluated the quality of the included literatures using the JBI Evidence-based Health Care Center evaluation tool and the Appraisal of Clinical Practice Guidelines for Research and EvaluationⅡ(AGREEⅡ),extracted and summarized the best evidence for the nutritional intake goal and calculation of adult critically ill patients,and described the evidence.Results A total of 18 literatures were included,including 5 clinical guidelines,8 expert consensus,3 systematic reviews and 2 evidence summaries.After literature quality evaluation,18 articles were all enrolled.The evidence was summarized from the four aspects,including energy target calculation method,dose body weight,energy and protein intake target,and calculation method,24 pieces of the best evidence were finally formed.Conclusions The best evidence of energy and protein intake targets and calculation for critically ill patients was summarized based on evidence-based.Clinical medical staff can choose indirect calorimetry to calculate energy goals when equipment is available.Patient's height,body weight should be recorded accurately,dose body weight can be determined by body mass index(BMI).Meanwhile,blood urea nitrogen(BUN)loss,fat-free body weight,simple formulas and other methods should be used to continuously evaluate and adjust protein intake targets,to achieve the purpose of optimizing intensive nutrition support.