间接测热法对重症患者能量代谢的评定

发布时间：2018-01-03 23:10

本文关键词：间接测热法对重症患者能量代谢的评定　出处：《宁夏医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的采用间接测热法测量危重症期间机械通气患者的静息能量消耗（REE，kcal/d），，评估其静息能量消耗（REE，kcal/d）水平，探讨重症病人实际能量消耗状况及重症状态下营养代谢的相关影响因素。方法选择2012年8-9月及2014年1月在宁夏医科大学总医院综合ICU及心脑血管病医院综合ICU机械通气患者为研究对象，评估患者的危重病程度(APACHEⅡ评分)及营养风险评分（NRS2002）。采用间接测热法对患者的静息能量消耗(mREE,kcal/d)进行测定，将测量结果与临床医师根据患者病情所给的实际营养供给量（pREE,kcal/d）相对比；按照病程不同阶段、危重症不同程度，及有无全身炎症反应（SIRS）分组进行比较；根据能量缺失程度将其分为4组，比较4组间APACHEⅡ评分、住院时间及死亡率的关系；并采用多元回归对患者的一般信息和生化指标与静息能量消耗进行相关性分析。结果共纳入重症患者60例。（1）重症患者的实际营养供给量（pREE,1474.3±488.9kcal/d）整体水平明显低于间接测热法测量的静息能量消耗(mREE,1790.2±377.6kcal/d),(P0.05)；（2）病程不同阶段中，急性期组患者的pREE（1258.8±558.4kcal/d）明显低于mREE（1796.1±398.5kcal/d），两者差异有显著统计学意义（p0.001）；相对稳定期组患者两者之间差异无统计意义；（3）各组患者的pREE与mREE分别比较，APACHE II评分≥15组（1366.1±550.9VS1785.6±373.7kcal/d）、APACHE II评分15分组（1590.1±389.5VS1795.1±388.2kcal/d）、SIRS组（1430.1±434.1VS1892.1±383.5kcal/d）的、非SIRS组REE（1522.7±348.3VS1706.8±356.9kcal/d），各组间患者的pREE低于mREE,差异均有统计学差异（P0.05）；（4）能量亏损较严重组的平均APACHEⅡ评分增高、ICU住院日延长、28d死亡率增加，与相对能量平衡组比较，统计学差异均非常显著（P0.01）。（5）多元回归分析显示，心率、体重、体温与静息能量消耗存在关联性。年龄、APACHE II评分、血压、呼吸频率、呼吸商等指标无相关性。结论（1）重症患者的能量亏缺在病情越重，存在全身炎症反应状态下差值显著增大，并且住院时间相对延长，死亡率增高；（2）临床医师根据患者病情所给的营养供给量的整体水平明显低于间接测热法监测所得的静息能量消耗，尤其以急性期患者为主;(3)床旁即时间接能量测定法对临床营养调整有很好的指导意义。
[Abstract]:Objective to measure the resting energy expenditure (REE, kcal/d) in patients with mechanical ventilation during the critical care period by indirect calorimetry, evaluate the resting energy consumption (REE, kcal/d) level, and explore the actual energy consumption of severe patients and the related factors of nutritional metabolism in severe state.
Methods 8-9 months of 2012 and January 2014 in the General Hospital of Ningxia Medical University and ICU integrated hospital of cardiovascular and cerebrovascular disease patients with mechanical ventilation in the ICU as the research object, evaluation of patients with critical illness degree (APACHE score) and nutritional risk score (NRS2002). On resting energy expenditure in patients with indirect calorimetry (mREE, kcal/d) the actual nutrient supply were measured, the measurement results will be given to the patients and clinicians of (pREE, kcal/d) phase contrast; according to the different stage of the disease, critically ill patients in different degree, and there is no systemic inflammatory response (SIRS) were divided into three groups according to the degree of lack of energy; it can be divided into 4 groups, were compared between the 4 groups the relationship between APACHE score, hospitalization time and mortality; and by multivariate regression of patients with general information and biochemical indexes and resting energy expenditure were analyzed.
Results a total of 60 cases of severe patients. (1) the actual nutrient supply of critically ill patients (pREE, 1474.3 + 488.9kcal/d) was significantly lower than the overall level of indirect calorimetry measurements of resting energy expenditure (mREE, 1790.2 + 377.6kcal/d), (P0.05); (2) at different stages in acute stage patients pREE (1258.8 + 558.4kcal/d) was significantly lower than that of mREE (1796.1 + 398.5kcal/d), there was significant difference (p0.001); the difference between the relatively stable stage group were both no statistical significance; (3) the pREE and mREE groups were compared respectively, APACHE score of II = 15 group (1366.1 + 550.9VS1785.6 + 373.7kcal/d), APACHE II score of 15 groups (1590.1 + 389.5VS1795.1 + 388.2kcal/d), group SIRS (1430.1 + 434.1VS1892.1 + 383.5kcal/d) and non SIRS group REE (1522.7 + 348.3VS1706.8 + 356.9kcal/d), each group of patients with pREE was lower than mREE, there were statistically significant difference (P0.05); (4) The average energy loss of APACHE II strict reorganization of the ICU score, hospitalization days prolonged, 28d increased mortality, compared with the relative energy balance group, statistical differences were very significant (P0.01). (5) multiple regression analysis showed that the heart rate, body weight, body temperature and resting energy expenditure are related. Age, APACHE II score. Blood pressure, respiratory rate, respiratory quotient index had no correlation.
Conclusion (1) patients with severe energy deficit in more severe disease, systemic inflammatory response under the condition of difference increased significantly, and the hospitalization time is longer and the mortality increased; (2) the overall level of nutrient supply to the clinician according to the condition of patients was significantly lower than that between the measured resting energy with heat method monitoring consumption, especially in acute stage patients; (3) the bedside time with energy determination method has good clinical significance for the adjustment of nutrition.

【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R459.7

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