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  本文關(guān)鍵詞：間接測(cè)熱法對(duì)重癥患者能量代謝的評(píng)定　出處：《寧夏醫(yī)科大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 間接測(cè)熱法 靜息能量消耗 危重癥 機(jī)械通氣

【摘要】：目的采用間接測(cè)熱法測(cè)量危重癥期間機(jī)械通氣患者的靜息能量消耗（REE，kcal/d），，評(píng)估其靜息能量消耗（REE，kcal/d）水平，探討重癥病人實(shí)際能量消耗狀況及重癥狀態(tài)下?tīng)I(yíng)養(yǎng)代謝的相關(guān)影響因素。 方法選擇2012年8-9月及2014年1月在寧夏醫(yī)科大學(xué)總醫(yī)院綜合ICU及心腦血管病醫(yī)院綜合ICU機(jī)械通氣患者為研究對(duì)象，評(píng)估患者的危重病程度(APACHEⅡ評(píng)分)及營(yíng)養(yǎng)風(fēng)險(xiǎn)評(píng)分（NRS2002）。采用間接測(cè)熱法對(duì)患者的靜息能量消耗(mREE,kcal/d)進(jìn)行測(cè)定，將測(cè)量結(jié)果與臨床醫(yī)師根據(jù)患者病情所給的實(shí)際營(yíng)養(yǎng)供給量（pREE,kcal/d）相對(duì)比；按照病程不同階段、危重癥不同程度，及有無(wú)全身炎癥反應(yīng)（SIRS）分組進(jìn)行比較；根據(jù)能量缺失程度將其分為4組，比較4組間APACHEⅡ評(píng)分、住院時(shí)間及死亡率的關(guān)系；并采用多元回歸對(duì)患者的一般信息和生化指標(biāo)與靜息能量消耗進(jìn)行相關(guān)性分析。 結(jié)果共納入重癥患者60例。（1）重癥患者的實(shí)際營(yíng)養(yǎng)供給量（pREE,1474.3±488.9kcal/d）整體水平明顯低于間接測(cè)熱法測(cè)量的靜息能量消耗(mREE,1790.2±377.6kcal/d),(P0.05)；（2）病程不同階段中，急性期組患者的pREE（1258.8±558.4kcal/d）明顯低于mREE（1796.1±398.5kcal/d），兩者差異有顯著統(tǒng)計(jì)學(xué)意義（p0.001）；相對(duì)穩(wěn)定期組患者兩者之間差異無(wú)統(tǒng)計(jì)意義；（3）各組患者的pREE與mREE分別比較，APACHE II評(píng)分≥15組（1366.1±550.9VS1785.6±373.7kcal/d）、APACHE II評(píng)分15分組（1590.1±389.5VS1795.1±388.2kcal/d）、SIRS組（1430.1±434.1VS1892.1±383.5kcal/d）的、非SIRS組REE（1522.7±348.3VS1706.8±356.9kcal/d），各組間患者的pREE低于mREE,差異均有統(tǒng)計(jì)學(xué)差異（P0.05）；（4）能量虧損較嚴(yán)重組的平均APACHEⅡ評(píng)分增高、ICU住院日延長(zhǎng)、28d死亡率增加，與相對(duì)能量平衡組比較，統(tǒng)計(jì)學(xué)差異均非常顯著（P0.01）。（5）多元回歸分析顯示，心率、體重、體溫與靜息能量消耗存在關(guān)聯(lián)性。年齡、APACHE II評(píng)分、血壓、呼吸頻率、呼吸商等指標(biāo)無(wú)相關(guān)性。 結(jié)論（1）重癥患者的能量虧缺在病情越重，存在全身炎癥反應(yīng)狀態(tài)下差值顯著增大，并且住院時(shí)間相對(duì)延長(zhǎng)，死亡率增高；（2）臨床醫(yī)師根據(jù)患者病情所給的營(yíng)養(yǎng)供給量的整體水平明顯低于間接測(cè)熱法監(jiān)測(cè)所得的靜息能量消耗，尤其以急性期患者為主;(3)床旁即時(shí)間接能量測(cè)定法對(duì)臨床營(yíng)養(yǎng)調(diào)整有很好的指導(dǎo)意義。
[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.

【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R459.7

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