There is little research that focuses on the relationship between the gut,metabolism,nutritional support and COVID-19.As a group of Chinese physicians,nutritionists and scientists working on the frontline treating COV...There is little research that focuses on the relationship between the gut,metabolism,nutritional support and COVID-19.As a group of Chinese physicians,nutritionists and scientists working on the frontline treating COVID-19 patients,we aim to integrate our experiences and the current clinical evidence to address this pressing issue in this article.Based on our clinical observations and available evidence,we recommend the following practice.Firstly,the Nutritional Risk Screening 2002 tool should be used routinely and periodically;for patients with a score≥3,oral nutritional supplements should be given immediately.Secondly,for patients receiving the antiviral agents lopinavir/ritonavir,gastrointestinal side effects should be monitored for and timely intervention provided.Thirdly,for feeding,the enteral route should be the first choice.In patients undergoing mechanical ventilation,establishing a jejunal route as early as possible can guarantee the feeding target being achieved if gastric dilatation occurs.Fourthly,we suggest a permissive underfeeding strategy for severe/critical patients admitted to the intensive care unit during the first week of admission,with the energy target no more than 20 kcal/kg/day(for those on mechanical ventilation,this target may be lowered to 10–15 kcal/kg/day)and the protein target around 1.0–1.2 g/kg/day.If the inflammatory condition is significantly alleviated,the energy target may be gradually increased to 25–30 kcal/kg/day and the protein target to 1.2–1.5 g/kg/day.Fifthly,supplemental parenteral nutrition should be used with caution.Lastly,omega-3 fatty acids may be used as immunoregulators,intravenous administration of omega-3 fatty emulsion(10 g/day)at an early stage may help to reduce the inflammatory reaction.展开更多
目的探讨间接能量测定法指导个体化营养方案对休克型肺炎患者能量代谢的影响。方法选择2020年1月至2023年1月在连云港市第二人民医院接受治疗的96例休克型肺炎患者,分别采用间接能量测定法(能量代谢监护仪)计算每日静息能量消耗(REE)值...目的探讨间接能量测定法指导个体化营养方案对休克型肺炎患者能量代谢的影响。方法选择2020年1月至2023年1月在连云港市第二人民医院接受治疗的96例休克型肺炎患者,分别采用间接能量测定法(能量代谢监护仪)计算每日静息能量消耗(REE)值,根据随机数字表法分为观察组(48例)与对照组(48例),观察组制定个体化营养方案,对照组采用匀浆膳方案。比较两组患者营养支持治疗前后蛋白质代谢营养指标、上臂肌围、体质量指数、血糖及预后情况。结果观察组治疗2周后总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)水平、上臂肌围、体质量指数[分别为(66.42±12.37)g·L^(-1),(38.44±3.25)g·L^(-1),(28.37±2.89)g·L^(-1),(25.96±2.03)cm,(22.93±1.62)kg·m^(-2)]均高于对照组[分别为(58.57±11.48)g·L^(-1),(34.37±3.89)g·L^(-1),(24.88±3.16)g·L^(-1),(23.87±1.89)cm,(21.64±1.58)kg·m^(-2)](t=3.223,5.563,5.646,5.221,3.950,均P<0.05),而空腹血糖(FPG),餐后2 h血糖(2 h PG)水平[分别为(6.36±1.02)mmol·L^(-1),(8.05±1.64)mmol·L^(-1)]均低于对照组[分别为(7.54±1.09)mmol·L^(-1),(9.87±1.52)mmol·L^(-1)](t=5.476,5.639,均P<0.05)。观察组机械通气时间,ICU住院时间,28 d病死率及发热发生率[分别为(9.09±1.48)d,(15.36±1.78)d,18.75%,8.33%]均低于对照组[分别为(10.37±1.56)d,(17.49±1.67)d,27.08%,22.92%](t=4.124,6.046,χ^(2)=0.944,3.872,均P<0.05)。结论间接能量测定法指导个体化营养方案能有效改善休克型肺炎患者营养状况及预后。展开更多
基金supported by the Joint Program for Fighting COVID-19,from the Sichuan Department of Science and Technology(grant number:2020YFS0006,to HJ)funding to the Sichuan Provincial Research Center for Emergency Medicine and Critical Illness,also from the Sichuan Department of Science and Technology(grant number:2019YFS0534,to JZ)supported by the Health Commission of Sichuan Province(grant number:20ZDCX002).
文摘There is little research that focuses on the relationship between the gut,metabolism,nutritional support and COVID-19.As a group of Chinese physicians,nutritionists and scientists working on the frontline treating COVID-19 patients,we aim to integrate our experiences and the current clinical evidence to address this pressing issue in this article.Based on our clinical observations and available evidence,we recommend the following practice.Firstly,the Nutritional Risk Screening 2002 tool should be used routinely and periodically;for patients with a score≥3,oral nutritional supplements should be given immediately.Secondly,for patients receiving the antiviral agents lopinavir/ritonavir,gastrointestinal side effects should be monitored for and timely intervention provided.Thirdly,for feeding,the enteral route should be the first choice.In patients undergoing mechanical ventilation,establishing a jejunal route as early as possible can guarantee the feeding target being achieved if gastric dilatation occurs.Fourthly,we suggest a permissive underfeeding strategy for severe/critical patients admitted to the intensive care unit during the first week of admission,with the energy target no more than 20 kcal/kg/day(for those on mechanical ventilation,this target may be lowered to 10–15 kcal/kg/day)and the protein target around 1.0–1.2 g/kg/day.If the inflammatory condition is significantly alleviated,the energy target may be gradually increased to 25–30 kcal/kg/day and the protein target to 1.2–1.5 g/kg/day.Fifthly,supplemental parenteral nutrition should be used with caution.Lastly,omega-3 fatty acids may be used as immunoregulators,intravenous administration of omega-3 fatty emulsion(10 g/day)at an early stage may help to reduce the inflammatory reaction.
文摘目的探讨间接能量测定法指导个体化营养方案对休克型肺炎患者能量代谢的影响。方法选择2020年1月至2023年1月在连云港市第二人民医院接受治疗的96例休克型肺炎患者,分别采用间接能量测定法(能量代谢监护仪)计算每日静息能量消耗(REE)值,根据随机数字表法分为观察组(48例)与对照组(48例),观察组制定个体化营养方案,对照组采用匀浆膳方案。比较两组患者营养支持治疗前后蛋白质代谢营养指标、上臂肌围、体质量指数、血糖及预后情况。结果观察组治疗2周后总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)水平、上臂肌围、体质量指数[分别为(66.42±12.37)g·L^(-1),(38.44±3.25)g·L^(-1),(28.37±2.89)g·L^(-1),(25.96±2.03)cm,(22.93±1.62)kg·m^(-2)]均高于对照组[分别为(58.57±11.48)g·L^(-1),(34.37±3.89)g·L^(-1),(24.88±3.16)g·L^(-1),(23.87±1.89)cm,(21.64±1.58)kg·m^(-2)](t=3.223,5.563,5.646,5.221,3.950,均P<0.05),而空腹血糖(FPG),餐后2 h血糖(2 h PG)水平[分别为(6.36±1.02)mmol·L^(-1),(8.05±1.64)mmol·L^(-1)]均低于对照组[分别为(7.54±1.09)mmol·L^(-1),(9.87±1.52)mmol·L^(-1)](t=5.476,5.639,均P<0.05)。观察组机械通气时间,ICU住院时间,28 d病死率及发热发生率[分别为(9.09±1.48)d,(15.36±1.78)d,18.75%,8.33%]均低于对照组[分别为(10.37±1.56)d,(17.49±1.67)d,27.08%,22.92%](t=4.124,6.046,χ^(2)=0.944,3.872,均P<0.05)。结论间接能量测定法指导个体化营养方案能有效改善休克型肺炎患者营养状况及预后。
