人工智能时代的脓毒症营养支持治疗

Nutritional support therapy for sepsis in the artificial intelligence era

  • 摘要: 脓毒症是重症监护室中常见的危重情形之一,是由病原体感染引发,包括全身炎性反应综合征在内的多种宿主反应失调,严重者可导致多器官功能障碍以至死亡。脓毒症患者异质性大,能量蛋白质和其他营养素的需求差异显著,病情变化快,需制订个体化的营养方案,并依据患者病情演化发展程度及时调整。虽然近20年来国际性学术组织已经发布相关临床指南,但其所依赖的大型临床试验结果高度不一致,使指南的推荐意见差异大,尤其是在能量、蛋白质推荐量、早期肠内营养启动时机等关键问题上。笔者认为:解决上述难题需要通过引入人工智能技术,以数据驱动‑机理牵引为理念,构建对具有时空变化过程的问题,进行深入探讨的数字孪生模型。数字孪生模型可动态、精确模拟不同剂量能量‑蛋白质摄入后在各种代谢、病理生理条件下对机体的作用,实现对营养治疗作用的全程监测、分析与预测。当数字孪生模型部署于临床后,还将经由真实数据和人工智能持续迭代更新,实现“一人一策、精准营养、优化治疗”的目标,最终降低患者的病死率并提升医疗质量。

     

    Abstract: Sepsis is the most common and dangerous condition in intensive care unit (ICU). Sepsis is caused by various pathogens and leads to systemic inflammation and immune disorders. Severe sepsis will impair multiple organs' function and result in death. Septic patients are highly variable, and their requirements for energy, proteins, and other nutrients are quite different. In addition, the pathophysiological conditions of septic patients are changing very fast, individualized nutritional plans need to be formulated and timely adjusted according to the evolution and progre-ssion of the patient's condition. In recent two decades, international clinical organizations have released many clinical guidelines. However, due to the major large-scale randomized control trials that these guidelines relied on being highly inconsistent, the differences in recommendations between these guidelines are huge, which are especially exhibited in recommendations on the energy and protein targets and the timing of initiation of enteral nutrition. The authors propose that addressing the aforementioned challenges necessitates the integration of artificial intelligence technology. Guided by the principle of data-driven and mechanism-informed integration, a digital twin model should be established to conduct in-depth investigations into problems characterized by spatiotemporal dynamic processes. This digital twin model can dynamically and precisely simulate the effects of different energy-protein intakes for various metabolic and pathophysiological statuses, thereby encompassing monitoring, analysis, prediction, and prescription for the entire nutritional treatment process.Once the digital twin model is deployed in clinical practice, it will be continuously iterated and updated through real-world data and artificial intelligence. This enables the achievement of the goal of "personalized strategy, precise nutrition, and optimized treatment", ultimately reducing patient mortality and improving medical quality.

     

/

返回文章
返回