Optimal protein requirements during the first 2 weeks after the onset of critical illness
Optimal protein requirements during the first 2 weeks after the onset of critical illness
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DOI：
10.1097/00003246-199809000-00020
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发表时间：
1998-09-01
影响因子：
8.8
通讯作者：
Hill, GL
中科院分区：
文献类型：
--
作者：
Ishibashi, N;Plank, LD;Hill, GL
目的：获得重症脓毒症或创伤患者在进入重症监护病房后的前 2 周内的最佳蛋白质需求。设计：回顾性研究。地点：教学医院的重症监护医学科。患者：创伤后立即患者或严重脓毒症患者。干预措施：使用体内中子活化分析来测量 10 天内总体蛋白质的变化，该变化在患者血流动力学稳定后立即开始。患者（创伤，n = 18；脓毒症，n = 5）根据平均每日蛋白质摄入量分为三组。由于患者水合过度（大约 10 L）且体内脂肪含量不一，因此蛋白质摄入量与正常水合（校正）无脂质量 (FFMc) 挂钩：A、B 和 C 组平均每天分别摄入 1.1、1.5 和 1.9 g/kg FFMc 蛋白质。测量和主要结果：总体而言，全身蛋白质的平均损失为 1.2 +/- 0.7 （标准差）千克。三组之间总体蛋白质的变化显着不同 (p = 0.011)。与 B 组 (p = 0.013) 和 C 组 (p = 0.023) 相比，A 组的身体蛋白质损失明显更多。当蛋白质摄入量从 1.1 g/kg FFMc/天增加到 1.5 g/kg FFMc/天时，蛋白质摄入量减半。蛋白质摄入量进一步增加至 1.9 g/kg FFMc/天，但没有进一步改善。每天 1.5 克/公斤 FFMc 的摄入量相当于研究开始时测量的体重 1.0 克/天/公斤。结论：如果将其与危重疾病发作后不久测量的体重挂钩，则目前建议的蛋白质需求量为 1.2 至 2.0 克/公斤体重/天是过量的。由于个别患者在发病早期存在不同程度的水分过多，因此我们建议重症医生应获取病前体重信息，并开出1.2克蛋白质/公斤体重/天的处方。如果没有可用信息，则 1.0 克蛋白质/天/公斤测量体重将大致接近最佳蛋白质需求量。 (Crit Care Med 1998；28：1529-1535)。
Objective: To obtain optimal protein requirements in critically ill sepsis or trauma patients during the first 2 wks after admission to the intensive care unit.Design: Retrospective study.Setting: Department of critical care medicine at a teaching hospital.Patients: Immediate posttrauma patients or severely septic patients.Interventions: In vivo neutron activation analysis was used to measure changes in total body protein over a 10-day period which began as soon as the patients were hemodynamically stable. The patients (trauma, n =18; sepsis, n = 5) were divided into three groups according to the average daily protein intakes. Because the patients were overhydrated (similar to 10 L) and had variable amounts of body fat, the protein intakes were indexed to normally hydrated (corrected) fat-free mass(FFMc): Groups A, B, and C received an average of 1.1,1.5, and 1.9 g/kg FFMc/day protein, respectively.Measurements and Main Results: Overall, the average loss of total body protein was 1.2 +/- 0.7 (SD) kg. Changes in total body protein were significantly (p =.011) different between the three groups. The loss of body protein was significantly more in group A compared with groups B (p =.013) and C (p =.023). When the protein intake was increased from 1.1 g/kg FFMc/day to 1.5 g/kg FFMc/day, protein lass was halved. Further increase in protein intake up to 1.9 g/kg FFMc/day resulted in no further improvement. An intake of 1.5 g/kg FFMc/day was equivalent to 1.0 g/day/kg of body weight measured at the beginning of the study.Conclusions: Current recommended protein requirements of 1.2 to 2.0 g/kg of body weight/day are excessive if they are indexed to the body weight measured soon after the onset of critical illness. Because individual patients have varying degrees of overhydration early in the illness onset, we suggest that the intensivist should obtain information on preillness body weight and prescribe 1.2 g of protein/kg body weight/day. If information is not available, 1.0 g of protein/day/kg of measured body weight will give a fair approximation to optimal protein requirements. (Crit Care Med 1998; 28:1529-1535).