体外膜肺氧合患者早期营养现状及预后分析

Analysis of early nutritional status and prognosis of patients during extracorporeal membrane oxygenation

目的观察早期能量摄入量及启动早期肠内营养对体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)患者预后的影响。方法选择2021年1月至2022年6月在江苏省人民医院(南京医科大学第一附属医院)急诊监护病房接受ECMO治疗的患者作为研究对象,总结ECMO患者早期能量摄入情况,通过Logistic回归分析及限制性立方样条(restricted cubic splines,RCS)分析明确ECMO患者早期能量摄入量与预后之间的具体关系,依据RCS分析结果选定截断值将患者分为能量欠缺组和能量丰富组,并以是否启动早期肠内营养(early enteral nutrition,EEN)将患者分为EEN组和非EEN组,比较能量欠缺组和能量丰富组以及EEN组和非EEN组间的临床结局之间的差异。结果能量欠缺组及能量丰富组、EEN组及非EEN组的年龄、性别、BMI、原发疾病、ECMO模式差异无统计学意义。能量欠缺组的生存率明显低于能量丰富组[43.2%(19/44)vs.66.0%(31/47),P=0.029];Kaplan-Meier生存分析提示能量欠缺组的28 d生存率明显低于能量丰富组,且死亡风险是能量丰富组的2.595倍(P=0.004)。EEN组的日均能量摄入量[kcal/(kg·d)]高于非EEN组(P<0.05),且生存率明显高于非EEN组[66.1%(41/62)vs.31.0%(9/29),P=0.002];Kaplan-Meier生存分析提示非EEN组的28 d生存率明显小于EEN组,且死亡风险是EEN组的2.981倍(P<0.001)。结论ECMO患者中普遍存在能量摄入不足,ECMO患者的能量摄入在16.94 kcal/(kg•d)以上时对预后是保护性因素,EEN有助于提高ECMO患者早期能量摄入量及改善预后。

Objective To observe the effects of early energy intake and early enteral nutrition on prognosis of patients during extracorporeal membrane oxygenation(ECMO).Methods Patients who received ECMO treatment in the emergency intensive care unit(EICU)of the Jiangsu Provincial Hospital(First Affiliated Hospital of Nanjing Medical University)from January 2021 to June 2022 were selected as subjects to summarize the early energy intake of ECMO patients.Logistic regression analysis and restricted cubic spline(RCS)analysis were used to determine the relationship between early energy intake and prognosis of ECMO patients.According to the results of RCS analysis,the patients were divided into energy-deficient group and energy-sufficient group.And according to whether early enteral nutrition(EEN)was initiated,the patients were divided into EEN group and non-EEN group.The differences of clinical outcomes between energy-deficient group and energy-sufficient group,EEN group and non-EEN group were compared.Results There was no significant difference in age,sex,BMI,primary disease and ECMO pattern between energy-deficient group and energy-sufficient group,EEN group and non-EEN group.The ECMO conversion time(days)and hospitalization time(days)in the energy-deficient group were significantly lower than those in the energy-sufficient group,and the survival rate in the energydeficient group was significantly lower than that in the energy-sufficient group[43.2%(19/44)vs.66.0%(31/47),P=0.029].Kaplan-Meier survival analysis showed that the 28-day survival rate in the energydeficient group was significantly lower than that in the energy-sufficient group,and the risk of death was 2.595 times higher than that in the energy-sufficient group.The conversion time(days),hospital stay(days)and average daily energy intake[kcal/(kg•d)]in the EEN group were higher than those in the non-EEN group(P<0.05),and the survival rate in the non-EEN group was significantly higher than that in the non-EEN group[66.1%(41/62)vs.31.0%(9/29),P<0.002].Kaplan-Meier survival analysis showed that the 28-day survival rate in the non-EEN group was significantly lower than that in the EEN group,and the risk of death was 2.981 times higher than that in the EEN group(P<0.001).Conclusions The energy intake of patients with ECMO above 16.94 kcal/(kg•d)is a protective factor for prognosis.EEN helps to increase early energy intake and improve prognosis in patients during ECMO.