A clinical nutritionist's search for meaning: why should we bother to feed the acutely ill, hospitalized patient?
A clinical nutritionist's search for meaning: why should we bother to feed the acutely ill, hospitalized patient?
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临床营养师寻找意义：我们为什么要费心去喂养重症住院患者？
DOI：
10.1016/s0899-9007(97)85072-2
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发表时间：
1996
期刊：
影响因子：
--
通讯作者：
Mason,JB
中科院分区：
文献类型：
--
作者：
Mason,JB
由于营养物质消耗、同化和代谢的相关改变，急性和慢性疾病通常会导致蛋白质-能量营养不良 (PEM)。因此，营养不良仍然是美国现代医院的一个普遍问题。 20世纪70年代中期，在城市教学医院进行的调查显示，3040%的成人内科和外科住院患者有严重营养不良的迹象。最近的研究表明这个问题的严重性没有改变。 3-5 此外，某些患者群体（例如患有 Childs A 级肝硬化的患者）普遍存在营养不良，但传统的临床评估并不明显。 6 直觉上，几乎所有人都同意，为重症住院患者提供充足且适当的营养至关重要。然而，通过肠内或肠外途径的积极营养支持与相当大的成本以及明显的发病和死亡风险相关。因此，有理由询问是否存在令人信服的科学证据表明，在急性疾病人群中使用现代营养支持可以带来具体的医疗或经济利益；下面详细介绍了对此问题的关键回答。蛋白质能量营养不良是由于满足身体代谢需求所需的蛋白质和/或能量数量持续不足而引起的病症。当饮食摄入不足导致无法满足代谢需求时，就会发生原发性 PEM。二次 PEM 出现
Acute and chronic iunesses commonly produce protein-energy malnutrition (PEM) due to associated alterations in the consumption, assimilation, and metabolism of nutrients. Consequently, malnutrition remains a pervasive problem in modem-day hospitals in the United States. In the mid-197Os, surveys performed in urban teaching hospitals ‘.* indicated that 3040% of adult medical and surgical inpatients had indications of significant malnutrition. More reCent studies indicate that the magnitude of this problem has not changed. 3-5 Furthermore, malnutrition among some groups of patients, such as those with Childs Class A cirrhosis, is pervasive and yet not evident by conventional clinical assessment. 6 Intuitively, nearly everyone agrees that the provision of adequate and appropriate nutrition to acutely ill, hospitalized patients is of paramount importance. Nevertheless, aggressive nutritional support through enteral or parenteral routes is associated with considerable cost and a distinct risk of morbidity and mortality. It is therefore reasonable to ask whether compelling scientific evidence exists that indicates that the use of modem day nutritional support in the acutely ill population provides concrete medical or financial benefits; detailed below is a critical response to this query.Protein-energy malnutrition is a condition arising from a sustained inadequacy in the quantity of protein and/or energy needed to meet the metabolic demands of the body. Primary PEM occurs when this inability to meet metabolic demands arises from insufficient dietary intake. Secondary PEM arises