!bJ+,. (intensivecareunit,icu) < ECMO 1994 Anderson [12] 240 E+ ( <F! C VV ECMO VA ECMOGH C- IJ K D LLMN [13],b JO /0! [5,

Size: px

Start display at page:

Download "!bJ+,. (intensivecareunit,icu) < ECMO 1994 Anderson [12] 240 E+ ( <F! C VV ECMO VA ECMOGH C- IJ K D LLMN [13],b JO /0! [5,"

亵欧经
7 years ago
Views:

1 53 张黎孙兵贺航咏李绪言童朝晖 <= >?89 ( FG5H8 9 IJ+, KKLDMNO, MNO PQRSTUVWX Y, ZQ[\]^_`, a@]^bc Z _ ECMO ]^, _ ECMO ]^ YR!" <= >?; ; < Nutritionsupportforadultpatientsundergoingextracorporealmembraneoxygenation ZhangLi,Sun Bing,HeHangyong,LiXuyan,TongZhaohui.DepartmentofRespiratoryandCriticalCareMedicine,Beijing Chao YangHospital,CapitalMedicalUniversity,BeijingInstituteofRespiratoryMedicine,BeijingKeyLaborato ryofrespiratoryandpulmonarycirculationdisorders,beijingengineringresearchcenterfordiagnosisand TreatmentofRespiratoryandCriticalCareMedicine,Beijing100020,China Corespondingauthor:ZhangLi,E mail:zhangli 1983@163.com Abstract Extracorporealmembraneoxygenation(ECMO)isanovelmechanicalsystemthatprovides respiratoryand/orhemodynamicsupporttopatientswithsevererespiratoryorcardiacfailure.thesepatients generalydevelopastateofincreasedmetabolicactivityaccompaniedbyelevatedcatabolismofproteinandneg ativenitrogenbalance.moreover,provisionofadequatenutritionaltherapyishardtoachieveduetovariousfac tors.nutritionsupportforthesepatientsishenceacriticalisue.thisarticleprovidesabriefoverviewofthe curentliteratureregardingnutritionalsupportduringecmoinadultpatients,asnocurentguidelinesaddres thisisue. Keywords Extracorporealmembraneoxygenation;Enteralnutrition;Parenteralnutrition < = >? (extracorporealmembraneoxygenation, ECMO)@b *+ ( /: ( ]^ 89, <= >? (venovenous extracorporealmembraneoxygenation,vv ECMO) C D ( <= >? (venoarterialextracorpo realmembraneoxygenation,va ECMO) C D : [1],AB,ECMO C B ]^@+, bc+ M, CD1 +, C b *+,IJ LDMNO O U Y, S M <]^, b STUVW X,, [2] IJ DOI: /cma.j.isn X :100020!"#$%&' " ()* +,"%# (-./01 () ()*+,456789/0: ; :,E mail:zhangli 1983@163.com LD % C$ T Y,, ZQ[\ M ST / ]^_` _ +, F ECMO]^ b ]^ [3],@ D C ECMO]^, ]^, bj c 2 [4 9],!" < ECMO () *+,]^ (,;-./01 Y [` 7, c ECMO 2 ]^ 34 [10] ;- PubMed56789 extracorporealmembrane oxygenation + nutrition QR: ; <=>? + ]^ 56, ECMO]^ YR 7 % 1 ECMO D ECMO >R C$T, <! =S>?, 2@ EC MO1 A =S BCD E [11],

2 !bJ+,. (intensivecareunit,icu) < ECMO 1994 Anderson [12] 240 E+ ( <F! C VV ECMO VA ECMOGH C- IJ K D LLMN [13],b JO /0! [5,9] 2004 Scot [5] b 270 VV ECMO ( :O /0, 260 (96%) ( <),! 24~36h,180,1 P Q QR R)S 7 T, Umez awamakikado [9] 2013 b!: <# ICU VA ECMO ]^ 2 U VW /0, X S! VA 25kcal/(kg d)[105kj/(kg d)],! 4d [\_`, 1Y - 70%,1 C P 7 T, 2015 * [14] : 9 VA ECMO b VW /0,X A Ridley [15] F b U : V W /0 )*@ ECMO.C 2 ECMO Y _ ECMO ]^ 7/0Q O / Lukas [7] bc+, 480 ECMO (350 VA ECMO,130 VV ECMO ) O /0,*/0@!bc:? ICUZ, +, # <#R[F +, R: \],/ 0 ECMO ]^[`^ 55%, VA ECMO [`^ 50%,VV ECMO [`^ 76%,_ A`%aD;[`7! < b c a D ` % (52% 61%; P=0 345) ECMO ]^[`7,&S +,: ( O 93 5 ), Z ]^` ( T Q C < ),$T C, E,! ECMO a,ecmo (&Q;- Z ]^`, S C, CQ, PT, 5,B ECMO [` Ferie [8] b 860 ECMO O /0, +, 550 ( VV ECMO 310 VA ECMO,1! ICU 13 1h 2 6d[\_`, 20 [ \_` C <,330, 200 C,180? <Q [\_`,_`ST ` C Schofield () 1 1~1 2), _`T 1 2g/(kg d) [16],! ECMO ad `% (P= 0 4) 3 ECMO!+, -7, ) 7 -. E+7 O Y, ) b C V (subjectiveglobalasesment,sga) E 2002(NutritionalRiskScreening2002,NRS2002) [16],' b, J ]^ NRS2002_ -. Y M,-.Y 7,Y +, T (bodymasindex, BMI) A T% 7 1Y T 7,? D+, ZQ T ; Y ZQO, M`, C+, Heyland [17]! 2011 CD+, F M *+, E (Nu tritionriskinthecriticalyil,nutric) M, M +, ) M (AcutePhysiologyand ChronicHealthEvaluationⅡ,APACHEⅡ) ` M (SequentialOrganFailureAsesment,SOFA) #?T, ICU B 6,M +,.b^, ]^&Q M ( 6M) +, _ ECMO ",NUTRIC M& ECMO.C T +, T BMI!b 1334 /0 T )bce 7 BMI Y M b! 3c ICU 1400 C ECMO]^ (? /0 BMI) ICU <^ 7 [19], a, T BMI! ( T O M : VA ECMO]^ T) <U 7 [20], BMI 7 ECMO ]^ ) R+, b, =S,)! ICU 24~48h T!I 48~72h[\_ `,2d S[\_` C < [21 22] +, Q, Q &Q E, A MetaM! ^ ICU QR.b^, Q ad [23], LL+,D DS

3 55 4 ECMO ST]^@ ^O MNO 78 b C ST ( ` ) ST B` ST, > > `! [22] ECMO "# S$ % 5, a S C ST B` ST +, b & D ' T B,) S b Q 25kcal/(kg d) [105kJ/(kg d)] B` ST,! 2~3d[\_`, T C T ` [21 22] D (BMI>30kg/m 2 ), C 22~25kcal/(kg d)[92~105kj/(kg d)] `, T C T [22] -. [F MNO,+,? T Q () MN1 * T 1 3~1 5g/(kg d),t+; -.E+7,) <FR,-#$, c.,!/ 0 O5H [24] 78, M/0 ' C <, 1 &Q.b^ ICU [25], a L 1 T 0 2~0 4g/(kg d), -! ECMO /0@? T 2g/(kg d), D 2 (>10mmol/L) )+,.b^ 7,]^-7) 2,34 2,,- 7T, [21 22] ECMO 5T.+,;.#$% ^ U [26], a 67 ECMO ( 97&Q,! M : ' C; B[\ T B b, a! ECMO & #$% C, < S # $%&Q <= > C<!A,! ECMO /0 5 ECMO ]^ ` ]^-7 B 7 `,+, _ ]^-7 _ [10] _+, 3c :O 7 7R R, O 7 `+, C C ) DN (6 E ) ; ( F GHI J K 7 L MN; 7 `+, O OB 5 B B ` Q ; R `+, B 12 D 3 24h;! ]^-7, _+,; ( 6 E GHI J K 7, Y `+,L MN C ) ;a<,:+, bj _ Y " P 5H), ` 7,C ` b,ij C ) %, JMNO )A M U 7,']^ M, Q C ) % [24] 6 ECMO ]^ 6 1 % : ] ^ -7 b$rs,ij b LD TY, U@+ : V, R R<Y W:, X [27] ]^ Y ECMO KKLD > ECMO5H ECMO5H R Y!Q, T, X E, R 7T, E = Z[ Z\ 6 2 C:+, T ]^, C T ( / _ / ` a T ) Q ^ b % ' C (, IJ &Q;- :c T X, [28] Q T [<5μg/(kg min)], = X,$ T, C [29] a c VW 6 3 C:' $T, C > O,&Q ECMO, D+, B,O > [30],@! ECMO 6 4 ECMO + E+T, ;.#$% K C, a &S [! ECMO Z ', S C C < [20] 7 ECMO]^ CXR ]^@ ICU D ECMO B,) bb&c B T Y _ 7D ECMO ]^ T, VA ECMO J Y C E, K!, K \ EC MO -7 bj+,_ ECMO]^) 7 /0, a $/ : ECMO /0 ; Ib" ]^ B " # $ % & [1] DelSorboL,CypeM, FanE. Extracorporeallifesupportfor adultswithsevereacuterespiratoryfailure[j].lancetrespir

4 Med,2014,2(2): DOI: /S (13) [2] AlberdaC,GramlichL,JonesN,etal.Therelationshipbetween nutritionalintakeandclinicaloutcomesincriticalyilpatients:re sultsofaninternationalmulticenterobservationalstudy[j].inten sivecaremed,2009,35(10): DOI: / s [3]JaksicT,HulMA,ModiBP,etal.A.S.P.E.N.Clinicalguide lines:nutritionsupportofneonatessupportedwithextracorporeal membraneoxygenation[j].jpenjparenterenteralnutr,2010,34 (3): DOI: / [4] UlerichL.Nutritionimplicationsandchalengesofthetransplant patientundergoingextracorporealmembraneoxygenationtherapy [J]. NutrClinPract, 2014, 29(2): DOI: / [5] ScotLK,BoudreauxK,ThaljehF,etal.Earlyenteralfeedingsin adultsreceivingvenovenousextracorporealmembraneoxygenation [J].JPENJParenterEnteralNutr,2004,28(5): [6]UmezawaMakikadoLD,FlordelísLasieraJL,Pérez VelaJL,et al.nutritionsupportduringextracorporealmembraneoxygenation (ECMO)inadults[J].IntensiveCareMed,2013,39(12): 2240.DOI: /s [7] LukasG,DaviesAR,HiltonAK,etal.Nutritionalsupportin adultpatientsreceivingextracorporealmembraneoxygenation[j]. CritCareResusc,2010,12(4): [8]FerieS,HerkesR,ForestP.Nutritionsupportduringextracor porealmembraneoxygenation(ecmo)inadults:aretrospective auditof86patients[j].intensivecaremed,2013,39(11): DOI: /s [9]UmezawaMakikadoLD,FlordelísLasieraJL,Pérez VelaJL,et al.earlyenteralnutritioninadultsrecceivngvenoarterialextracor porealmembraneoxygenation:anobservationalcaseseries[j]. JPENJParenterEnteralNutr,2013,37(2): DOI: / [10] FaríasMM,OlivosC,DíazR.Nutritionalimplicationsforthepa tientundergoingextracorporealmembraneoxygenation[j].nutrho sp,2015,31(6): DOI: /nh [11] KurundarAR,KilingsworthCR,MsIlwainRB,etal.Extracorpo realmembraneoxygenationcauseslosofintestinalepithelialbari erinthenewbornpiglet[j].pediatrres,2010,68(2): DOI: / [12] AndersonHL3rd,ShapiroMB,DeliusRE,etal.Extracorporeal lifesupportforrespiratoryfailureaftermultipletrauma[j].jtrau ma,1994,37(2): [13] CasaerMP,MesotenD,HermansG,etal.Earlyversuslatepar enteralnutritionincriticalyiladults[j].nengljmed,2011, 365(6): DOI: /NEJMoa [14] *,,,.]^!: <#9 <= >?. )C VW[J]. <),2015,22(2):88 91.DOI: /j x [15] RidleyEJ,DaviesAR,RobinsEJ,etal.Nutritiontherapyinadult patientsreceivingextracorporealmembraneoxygenation:aprospec tive,multicentre,observationalstudy[j].critcareresusc,2015, 17(3): [16] deulíbaripérezji,fernándezg,rodríguezsalvanésf,etal. Nutritionalscreening;controlofclinicalundernutritionwithanalyt icalparameters[j].nutrhosp,2014,29(4): DOI: /nh [17] HeylandDK,DhaliwalR,JiangX,etal.Identifyingcriticalyil patientswhobenefitthemostfromnutritiontherapy:thedevelop mentandinitialvalidationofanovelriskasesmenttool[j].crit Care,2011,15(6):R268.DOI: /cc [18]Al SoufiS,BuscherH,NguyenND,etal.Lackofasociationbe tweenbodyweightandmortalityinpatientsonveno venousextra corporealmembraneoxygenation[j].intensivecaremed,2013, 39(11): DOI: /s [19] SchmidtM,ZogheibE,RozéH,etal.ThePRESERVEmortality riskscoreandanalysisoflong term outcomesafterextracorporeal membraneoxygenationforsevereacuterespiratorydistressyn drome[j].intensivecaremed,2013,39(10): DOI: /s [20] SchmidtM,BurelA,RobertsL,etal.Predictingsurvivalafter ECMOforrefractorycardiogenicshock:thesurvivalafterveno arte rial ECMO(SAVE) score[j].eurheartj,2015,36(33): DOI: /eurheartj/ehv194. [21] SingerP,BergerMM,VandenBergheG,etal.ESPENGuidelineson ParenteralNutrition:intensivecare[J].ClinNutr,2009,28(4): DOI: /j.clnu [22] HeylandDK,DhaliwalR,DroverJW,etal.Canadianclinical practiceguidelinesfornutritionsupportinmechanicalyventilated, criticalyiladultpatients[j].jpen JParenterEnteralNutr, 2003,27(5), [23] HoKM,DobbGJ,WebbSA.A comparisonofearlygastricand post pyloricfeedingincriticalyilpatients:ameta analysis[j]. IntensiveCareMed,2006,32(5): [24]DennisRA,JohnsonLE,RobersonPK,etal.Changesinprealbu min,nutrientintake,andsystemicinflammationinelderlyrecupera tivecarepatients[j].jam GeriatrSoc,2008,56(7): DOI: /j x. [25]WischmeyerPE,DhaliwalR,McCalM,etal.Parenteralglutamine supplementationincriticalilnes:asystematicreview[j].critcare, 2014,18(2):R76.DOI: /cc [26]AlsousF,KhamieesM,DeGirolamoA,etal.Negativefluidbal ancepredictssurvivalinpatientswithsepticshock:aretrospective pilotstudy[j].chest,2000,117(6): [27]ScaraviliV,ZanelaA,SangaliF,etal.Basicaspectsofphysiolo gyduringecmo[a]//sangalif,patronitin,pesentia.ecmo ex tracorporeallifesupportinadults.milan:springer,2014: [28]WelsDL.Provisionofenteralnutritionduringvasopresortherapy

5 57 forhemodynamicinstability:anevidence basedreview[j].nutrclin Pract,2012,27(4): DOI: / [29] ThorénA,ElamM,RickstenSE.Diferentialefectsofdopamine, dopexamine,anddobutamineonjejunalmucosalperfusionearlyafter cardiacsurgery[j].critcaremed,2000,28(7): [30] NguyenNQ,ChapmanMJ,FraserRJ,etal.Erythromycinismore efectivethanmetoclopramideinthetreatmentoffeedintolerancein criticalilnes[j].critcaremed,2007,35(2): ( * : ) 櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒櫒 ' ()*++, -. /0.1 % 由中华医学会中华医学会肠外肠内营养学分会主办的中华医学会第十届全国肠外肠内营养学学术会议将于 2016 年 5 月 27~29 日在四川省成都市世纪城新国际会展中心举行, 我们欢迎相关专业的临床医师营养师药师与护理人员积极投稿并踊跃参会我们将同广大同仁一道, 秉承传承规范交流与创新的宗旨, 以肠功能衰竭与营养不良为学术重点, 引领中国肠外肠内营养学事业的学科建设与人才培养现将有关投稿及参会事宜通知如下 : 1 投稿领域 : 关于以下领域的系统评价随机对照研究队列研究观察研究病例报告与基础研究均可投稿 : 肿瘤营养儿科营养老年营养神经营养护理营养师药师快速康复其他 2 投稿要求 : 请通过会议网站进行在线投稿会议投稿及参会注册之前需要先注册个人账户提交 800 字以内摘要一份, 采用四段式写法, 包括 : 目的方法结果与结论若上传全文, 要求使用 Word2003 文件格式除特邀专题讲座稿件, 恕不接受电子邮件和邮寄投稿 ; 特邀专题讲座稿件请直接发送到 kangweiming@163.com 和 txchenwei@sina.com 论文要求科学合理, 逻辑严谨, 论点鲜明, 结果真实, 结论可靠, 文字通顺稿件应是未曾正式发表的原创性论文在线投稿时, 请选择稿件的相应类别 3 优秀论文评选 : 本次会议将从投稿论文中评选优秀论文优秀论文作者将获得证书和奖金 4 投稿截止日期 :2016 年 4 月 17 日, 截止日期前, 可在线修改摘要 5 投稿结果查询 : 征文将分为发言壁报与书面交流等形式审稿结果可于 2016 年 4 月底通过会议网站查询中华医学会肠外肠内营养学分会中华医学会学术会务部 2016 年 2 月