低热量对比正常热量营养用于重症患者的前瞻随机初步试验

德国莱比锡大学附属医院内科重症监护室

　　背景：重症患者最佳营养一直存在争议。本研究旨在初步比较对重症患者在重症监护病房（ICU）前7天进行正常热量喂养和低热量喂养的疗效。比较的主要观察指标为患者在ICU期间的院内感染率。

　　方法：本研究将入ICU后24h内需要人工营养至少72h的重症患者随机分为正常热量组（接受每天消耗能量的100%）和低热量组（接受每天消耗能量的50%）。

　　结果：共100例患者入组（其中正常热量组54例，低热量组46例）。其中男性66例和女性34例，平均年龄为65.8±11.6。正常热量组的平均每日补充热量19.7±5.7kcal/kg，低热量组的平均每日补充热量11.3±3.1kcal/kg（P=0.0001）。与低热量组相比，正常热量组的胰岛素需要量明显较高，胃肠不耐受发生较频繁。低热量组与正常热量组相比，院内感染发生较常见（分别为26.1%比11.1%）。正常热量组的ICU死亡率为22.2%，低热量组为21.7%（差异无统计学意义）。正常热量组的院内死亡率为31.5%，低热量组为37.0%（P=0.67）。

　　结论：与正常热量组相比，对重症患者在ICU前7天进行低热量喂养的院内感染较高，而胰岛素需要量和胃肠不耐受发生率较低。

JPEN J Parenter Enteral Nutr. 2016;40(2):242-9.

Hypocaloric vs Normocaloric Nutrition in Critically Ill Patients: A Prospective Randomized Pilot Trial.

Petros S, Horbach M, Seidel F, Weidhase L.

Medical Intensive Care Unit, University Hospital Leipzig, Leipzig, Germany.

BACKGROUND: Optimal nutrition of critically ill patients is still a matter of debate. This pilot trial aimed to compare the impact of normocaloric vs hypocaloric feeding in critically ill patients in the first 7 days in the intensive care unit (ICU). The primary end point was the rate of nosocomial infections during the ICU stay.

METHODS: Critically ill patients requiring artificial nutrition for at least 72 hours were included within 24 hours of ICU admission and randomized into a normocaloric group (receiving 100% of their daily energy expenditure) and a hypocaloric group (receiving 50% of their daily energy expenditure).

RESULTS: One hundred patients were included (54 in the normocaloric group and 46 in the hypocaloric group). There were 66 male and 34 female patients with a mean age of 65.8 ± 11.6 years. The mean daily caloric supply was 19.7 ± 5.7 kcal/kg for the normocaloric group and 11.3 ± 3.1 kcal/kg for the hypocaloric group (P = .0001). Insulin demand was significantly higher and gastrointestinal intolerance more frequent in the normocaloric group than in the hypocaloric group. Nosocomial infections were detected more frequently in the hypocaloric group than in the normocaloric group (26.1% vs 11.1%, respectively). The ICU mortality rate was 22.2% in the normocaloric group and 21.7% in the hypocaloric group (not significant). The hospital mortality rate was 31.5% in the normocaloric group and 37.0% in the hypocaloric group (P = .67).

CONCLUSION: Hypocaloric feeding in the first 7 days in critically ill patients was associated with more nosocomial infections but less insulin demand and less gastrointestinal intolerance compared with normocaloric feeding.

TRIAL REGISTRATION NUMBER: DRKS00000104 (German Clinical Trials Register).

KEYWORDS: critical illness; hypocaloric feeding; normocaloric feeding; nutrition; outcome

PMID: 24699555

DOI: 10.1177/0148607114528980