Нутритивная поддержка больных в критических состояниях (обзор)

В последнее десятилетие снизилась госпитальная летальность больных в критических состояниях. Одновременно увеличилось число пациентов, у которых был диагностирован синдром «После Интенсивной Терапии» (ПИТ-синдром), формирование которого приводит к снижению качества жизни больных, выписанных из стационара. Одним из наиболее важных компонентов, препятствующих развитию ПИТ-синдрома, является нутритивная поддержка.

Цель обзора: показать необходимость дифференцированного подхода к нутритивной поддержки больных в критических состояниях на этапах лечения и реабилитации.
Из более 200 первично отобранных источников литературы из различных баз данных (Scopus, Web of science, РИНЦ и др.) для анализа оставили 82 источника, в основном за последние 5 лет. Более ранние публикации использовали при сохранении их актуальности для клиницистов.
В обзоре представлены данные о реальной практике проведения нутритивной поддержки у больных в критических состояниях. Подчеркивается, что в большинстве случаев до начала лечения не оценивается риск нутритивной недостаточности, а потребности в белке и энергии удовлетворяются не полностью. На основании стадийности течения критического состояния представлен алгоритм проведения нутритивной поддержки.

Заключение. Современные подходы к обеспечению больных в критическом состоянии нутриентами и энергией предусматривают градацию назначения нутритивной поддержки в зависимости от стадии заболевания. Акцент делается на постепенном достижении целевых значений белка и энергии, преимущественном использовании энтерального способа доставки пищевых компонентов, преемственности в проведении нутритивной поддержки между отделениями, а также госпитальным и амбулаторным этапами лечения. Такой подход позволяет не только оптимизировать результаты оказания помощи этой крайне тяжелой категории пациентов, но и снизить выраженность и длительность проявления ПИТ-синдрома.

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