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ОЦЕНКА И ПРОГНОСТИЧЕСКАЯ ЗНАЧИМОСТЬ ПОКАЗАТЕЛЕЙ НУТРИТИВНОГО СТАТУСА У ТРАВМАТОЛОГИЧЕСКИХ И ХИРУРГИЧЕСКИХ ПАЦИЕНТОВ ОТДЕЛЕНИЙ РЕАНИМАЦИИ И ИНТЕНСИВНОЙ ТЕРАПИИ: СИСТЕМАТИЧЕСКИЙ ОБЗОР ЛИТЕРАТУРЫ
Аннотация
Нутритивная недостаточность (НН) является общепризнанным фактором риска развития неблагоприятного исхода у пациентов в критическом состоянии. Наличие или риск развития НН оценивается различными шкалами, индексами и лабораторными показателями. На сегодняшний день до конца не ясна их прогностическая ценность, особенно в сравнении с общеизвестными интегральными шкалами тяжести состояния пациентов , такими как APACHE-II и SOFA.
Цель обзора – определить прогностическую ценность методов скрининга и диагностики нутритивной недостаточности у пациентов отделения реанимации и интенсивной терапии (ОРИТ).
Материал и методы. В базах данных PubMed, Google Scholar отобраны и пронализированы 62 публикации, содержащие результаты научно-исследовательских работ по оценке прогностической значимости методов скрининга и диагностики нутритивной недостаточности у пациентов ОРИТ.
Результаты. Низкие значения лимфоцитов крови, белков плазмы – альбумина, трансферрина, преальбумина и высокие уровни С-реактивного белка ассоциированы с повышенным риском неблагоприятного исхода как при критических состояниях в травматологии, так и в общей хирургии. Такие специализированные как Nutritional risk index (NRI), Prognostic nutritional index (PNI), Maastricht Index (MI) также показали свою хорошую прогностическую ценность. Шкала mNUTRIC уступает по силе прогностической значимости в отношении летального исхода шкалам APACHE-II и SOFA. У пациентов хирургических ОРИТ шкала mNUTRIC сопоставима по силе прогностической способности со шкалами APACHE-II и SOFA. У реанимационных пациентов с политравмой шкалы NRS-2002, MUST, MNA-SF продемонстрировали идентичную оценку риска развития НН. Но шкала MNA-SF обладает большей прогностической силой в отношении прогнозирования летального исхода и количества повторных поступлений в стационар.
Заключение. Для оценки риска развития и тяжести НН в ОРИТ могут использоваться лабораторные маркеры (альбумин, трансферин, преальбумин, С-реактивный белок), специализированные прогностические индексы (NRI, PNI, MI), а также шкалы NRS-2002, mNUTRIC, MUST, MNA-SF.У пациентов хирургических ОРИТ шкала mNUTRIC может использоваться для прогнозирования неблагоприятного исхода заболевания. У пациентов с политравмой с этой целью можно применять шкалу MNA-SF.
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