不同身體質量指數之重症病人其營養支持狀況與臨床結果

The Status of Nutrition Support Therapy and Clinical Outcomes in Critical Illness Patients with Different BMI

劉詩玉(Shi-Yu Liu) ； 謝佳容(Chia-Jung Hsieh)

《台灣營養學會雜誌》 42卷4期 (2018/12) Pp. 111-120

https://doi.org/10.6691/NSJ.201812_42(4).0001

摘要

加護病房（intensive care unit, ICU）營養照護，是依世界各營養學會重症營養實證準則，執行營養支持處方，但鮮少以重症病人入院前的身體質量指數（body mass index, BMI）為影響因子來探究入ICU第一週營養支持對臨床結果之影響。本研究是以2011-2015年某醫學中心外科加護病房（surgical intensive care unit, SICU）病人之電子病歷紀錄；分別蒐集入院第一天24小時內有無營養支持、第三天及第七天總熱量及蛋白質攝取量紀錄。探討入ICU前不同體位之病人，在入ICU第一週內營養支持治療，逐日總熱量及蛋白質實際攝取量目標狀況，與影響重症治療短期間臨床結果的相關因素。共納入569名SICU病人。總熱量攝取的部分，對肥胖病人在SICU第一天立即給予腸道營養支持者相對於無營養支持者，呼吸器使用天數顯著增加3.33天（p = 0.007）。然而，在蛋白質攝取的部分，只要在SICU第一天立即給予蛋白質攝取的肥胖病人，呼吸器使用天數顯著縮短2.52天（p =0.018）。本研究發現，對於肥胖重症病人，在SICU第一天營養支持提供蛋白質，可以縮短呼吸器使用天數。BMI是影響重症病人營養支持在臨床結果上重要的因素。

關鍵字

重症營養支持 ； 身體質量指數 ； ICU住院天數 ； 呼吸器使用天數

並列摘要

Nutrition support therapy in the intensive care unit (ICU) is performed according to the evidence-based guidelines from international societies for parenteral and enteral nutrition. However, few of them have considered body mass index (BMI) of critically ill patients as a factor affecting the efficacy of nutrition support during the first week. The surgical intensive care unit (SICU) patients admitted from year of 2011 to 2015 were obtained from the database of electronic medical records management system. Nutrition support records within 24 hours of admission and total calorie and protein intakes in Day 3 and Day 7 were collected. We investigated the associations between daily total calorie/protein intake and short-term prognostic factors after critical care in different BMI SICU patients receiving nutrition support during the first week. A total of 569 SICU patients were enrolled. Comparing patients with no enteral nutrition support on the first day of SICU in patients with obesity, the days of respirator use was significantly increase by 3.33 days ( = 0.007) for the patients with enteral nutrition support. Compared with no protein intake, obese patients given protein uptake on the first day of SICU the days of respirator use was significantly reduced by 2.52 days ( = 0.018). The study found that provided protein on the first day of SICU in critical illness patients with obese patients can shorter the days of respirator use in SICU. BMI is an important factor for affecting the efficiency of nutrition support therapy in critical illness patients.

並列關鍵字

Critical nutritional support ； Body mass index ； ICU length of stay ； Mechanical ventuilator of days