肿瘤患者的营养治疗.pptVIP

* * * Bosaeus I等观察了297例接受姑息治疗的进展期肿瘤患者REE、体重的分布情况，REE用间接热卡仪测量（REE计算值），BMR用Harris-Benedict公式计算（REE预测值），REE/BMR110%定义为高代谢。他们发现，患者的平均REE为1533±269Kcal/d（23±4Kcal//kg/d），变化范围为930-2410Kcal/d(13-36Kcal//kg/d)；基础代谢率（basal metabolic rate，BMR）为1380±222Kcal/d。本组患者代谢率为Ｘ±SD=1.12±0.14，n=295，如图所示：尽管肿瘤患者的代谢状况差异较大，但是平均水平较高，说明肿瘤患者总体上处于高代谢状态。 * * Journal of Parenteral and Enteral Nutrition / Vol. 36, No. 1, January 2012 背景:在重症监护室的病人最佳营养被认为是同时提供通过间接量热法测定的能量和至少1.2 g / kg的蛋白质 方法:对886位需要机械通气的危重症患者进行营养支持并进行Cox 回归分析，观察28天内 蛋白质+能量达标、仅能量达标和都不达标患者的死亡率 结果:仅达到能量目标的患者28天内死亡风险（HR）为0.83，而同时实现能量+蛋白目标（每日≥1.2g/kg)的患者HR则降至0.47 结论:在对蛋白质和总能量供应进行优化后，28天患者的死亡率下降了50%，且仅能量达标是不能降低死亡率 Background: Optimal nutrition for patients in the intensive care unit has been proposed to be the provision of energy as determined by indirect calorimetry and the provision of protein of at least 1.2 g/kg. Methods: Prospective observational cohort study in a mixed medical-surgical intensive care unit in an academic hospital. In total, 886 consecutive mechanically ventilated patients were included. Nutrition was guided by indirect calorimetry and protein provision of at least 1.2 g/kg. Cumulative intakes were calculated for the period of mechanical ventilation. Cox regression was used to analyze the effect of protein + energy target achieved or energy target achieved versus neither target achieved on 28-day mortality, with adjustments for sex, age, body mass index, Acute Physiology and Chronic Health Evaluation II, diagnosis, and hyperglycemic index. Results: Patients’ mean age was 63 ± 16 years; body mass index, 26 ± 6; and Acute Physiology and Chronic Health Evaluation II, 23 ± 8. For neither target, energy target, and protein + energy target, energy intake was 75% ± 15%, 96% ± 5%, and 99% ± 5% of target, and protein intake was 72% ± 20%, 89% ± 10%, and 112% ± 12% of target, respectively. Hazard ratios (95% confidence interval) for energy target and protein + energy target were 0.83 (0.67–1.01) and 0.47 (0.31–0.73) for 28