能量消耗的测定在机械通气重症肺炎患儿中的临床应用
发布时间：2018-09-18 16:14
【摘要】：背景与目的:儿童重症肺炎病情的转归和患病儿童本身的营养状况具有密切关系,相关研究发现,患病儿童的营养基础代谢是病情的预后及转归的影响因素。患儿接受机械通气治疗后的能量代谢以及营养支持治疗是临床对此类病症进行综合治疗的关键步骤。本文着重于对机械通气治疗的重症肺炎患儿的静息能量消耗采用代谢车和H-B公式测量,以测定患儿治疗所需能量,以此为基础展开治疗。目的在于:①比较H-B公式与代谢车方法测定机械通气重症肺炎患儿能量消耗值的差异。②探讨两种能量测定方法在机械通气重症肺炎患儿营养支持治疗中的指导意义。方法:对2013年12月~2014年12月湖南省儿童医院重症医学科室收集治疗的100例上呼吸机的重症肺炎患儿展开研究,所有研究对象均为需要进行机械通气治疗的患儿,采用分组的方式对患儿进行研究调查,首先将100例患儿均予以代谢车和H-B公式计算能量消耗。再将研究对象随机分为A、B两组,每组各50例患儿:实验组:按代谢车测定静息能量消耗进行能量支持。对照组:按H-B公式计算能量消耗值进行营养支持。对患儿的REE值、血浆蛋白、肺功能及血气分析、疾病预后相关指标(ICU住院时间、死亡率、呼吸性相关肺炎的发生率、撤离呼吸机时间等)进行观察统计。并采用SPSS18.0专业统计学软件系统对研究数据进行分析评价,计数资料采用χ2检验,以%表示,计量资料以x±s表示,采用t检验;P0.05表示差异有显著统计学意义。结果:①100患儿间接测热法在第1、3、5d测量平均值低于H-B公式组,经统计学分析差异有意义(P0.05);第7d实验组患儿REE与对照组相近(P0.05),统计学无明显差异。②从血气分析来看,实验组患儿Pa O2和BE值较治疗前升高差值与对照组比较,经统计学分析差异有意义(P0.05),实验组患儿的Pa CO2、PH、LAC、和GLU较治疗前降低差值比较,经统计学分析两组治疗前后血气分析指标下降幅度存在差异(P0.05)。从感染指标来看,实验组患儿的CRP、PCT、WBC、LYM、NEU和血沉下降差值比较,经统计学分析差异有意义(P0.05)。从血浆蛋白来看,实验组患儿的血浆白蛋白、血浆球蛋白和血浆前蛋白增加差值与对照组比较,经统计学分析差异有意义(P0.05)。实验组患儿血浆总蛋白治疗前后降低差值与对照组比较,经统计学分析差异有意义(P0.05)。治疗后实验组患儿的血气分析指标、感染指标和血浆蛋白的值恢复正常的比例均高于对照组,经统计学分析差异有意义(P0.05)。③实验组患儿入住ICU时间、撤离呼吸机时间均较对照组短,呼吸机相关性肺炎的发生率低于对照组,上述指标比较差异显著(P0.05)。实验组患儿总住院时间短于对照组,P0.05,统计学差异显著。结论:①代谢车测量的REE提供的能量较H-B公式低,与传统的H-B公式相比,间接能量代谢法测定的静息能量消耗的结果更为准确,更接近正常儿童。②在重症肺炎机械通气患儿营养干预中,炎性指标有所好转,改善疾病预后,建议使用代谢车指导临床治疗。
[Abstract]:BACKGROUND AND OBJECTIVE: There is a close relationship between the prognosis of severe pneumonia in children and the nutritional status of the sick children. It is found that the nutritional metabolism of the sick children is the prognostic and prognostic factor of the disease. This paper focuses on the measurement of resting energy expenditure by metabolic vehicle and H-B formula in children with severe pneumonia treated by mechanical ventilation. The purpose of this study is to compare the energy expenditure measured by H-B formula with that measured by metabolic vehicle method in children with severe pneumonia treated by mechanical ventilation. Methods: A total of 100 children with severe pneumonia who received mechanical ventilation from December 2013 to December 2014 in the Department of Critical Care Medicine of Hunan Children's Hospital were studied. All the subjects needed mechanical ventilation. The patients of mechanical ventilation therapy were divided into two groups. First, 100 children were given metabolic vehicle and H-B formula to calculate energy consumption. Then the subjects were randomly divided into A and B groups, each group of 50 children: experimental group: according to the metabolic Vehicle measured resting energy consumption for energy support. Control group: according to H-B formula calculation. The EE value, plasma protein, pulmonary function and blood gas analysis, prognostic indicators (ICU length of stay, mortality, incidence of respiratory associated pneumonia, time to withdraw from ventilator, etc.) were observed and statistically analyzed. _2 test was used to test the counting data, and_2 test was used to express the counting data with% x 65 There was no significant difference in blood gas analysis. The difference of Pa O2 and BE between the experimental group and the control group was statistically significant (P 0.05). The difference of Pa CO2, PH, LAC and GLU between the experimental group and the control group was statistically significant (P 0.05). The difference (P 0.05). From the infection index, the difference of CRP, PCT, WBC, LYM, NEU and ESR in the experimental group was significant (P 0.05). From the plasma protein, the difference of plasma albumin, plasma globulin and plasma prealbumin between the experimental group and the control group was significant (P 0.05). 05). The difference of plasma total protein between the experimental group and the control group before and after treatment was statistically significant (P 0.05). After treatment, the blood gas analysis index, infection index and the ratio of plasma protein value returning to normal in the experimental group were higher than those in the control group, and the difference was statistically significant (P 0.05). 3. The total hospitalization time of the experimental group was shorter than that of the control group (P Compared with the indirect energy metabolism method, the results of resting energy expenditure were more accurate and closer to the normal children.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R725.6
[Abstract]:BACKGROUND AND OBJECTIVE: There is a close relationship between the prognosis of severe pneumonia in children and the nutritional status of the sick children. It is found that the nutritional metabolism of the sick children is the prognostic and prognostic factor of the disease. This paper focuses on the measurement of resting energy expenditure by metabolic vehicle and H-B formula in children with severe pneumonia treated by mechanical ventilation. The purpose of this study is to compare the energy expenditure measured by H-B formula with that measured by metabolic vehicle method in children with severe pneumonia treated by mechanical ventilation. Methods: A total of 100 children with severe pneumonia who received mechanical ventilation from December 2013 to December 2014 in the Department of Critical Care Medicine of Hunan Children's Hospital were studied. All the subjects needed mechanical ventilation. The patients of mechanical ventilation therapy were divided into two groups. First, 100 children were given metabolic vehicle and H-B formula to calculate energy consumption. Then the subjects were randomly divided into A and B groups, each group of 50 children: experimental group: according to the metabolic Vehicle measured resting energy consumption for energy support. Control group: according to H-B formula calculation. The EE value, plasma protein, pulmonary function and blood gas analysis, prognostic indicators (ICU length of stay, mortality, incidence of respiratory associated pneumonia, time to withdraw from ventilator, etc.) were observed and statistically analyzed. _2 test was used to test the counting data, and_2 test was used to express the counting data with% x 65 There was no significant difference in blood gas analysis. The difference of Pa O2 and BE between the experimental group and the control group was statistically significant (P 0.05). The difference of Pa CO2, PH, LAC and GLU between the experimental group and the control group was statistically significant (P 0.05). The difference (P 0.05). From the infection index, the difference of CRP, PCT, WBC, LYM, NEU and ESR in the experimental group was significant (P 0.05). From the plasma protein, the difference of plasma albumin, plasma globulin and plasma prealbumin between the experimental group and the control group was significant (P 0.05). 05). The difference of plasma total protein between the experimental group and the control group before and after treatment was statistically significant (P 0.05). After treatment, the blood gas analysis index, infection index and the ratio of plasma protein value returning to normal in the experimental group were higher than those in the control group, and the difference was statistically significant (P 0.05). 3. The total hospitalization time of the experimental group was shorter than that of the control group (P Compared with the indirect energy metabolism method, the results of resting energy expenditure were more accurate and closer to the normal children.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R725.6
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