【摘要】：背景與目的:兒童重癥肺炎病情的轉(zhuǎn)歸和患病兒童本身的營(yíng)養(yǎng)狀況具有密切關(guān)系,相關(guān)研究發(fā)現(xiàn),患病兒童的營(yíng)養(yǎng)基礎(chǔ)代謝是病情的預(yù)后及轉(zhuǎn)歸的影響因素�；純航邮軝C(jī)械通氣治療后的能量代謝以及營(yíng)養(yǎng)支持治療是臨床對(duì)此類病癥進(jìn)行綜合治療的關(guān)鍵步驟。本文著重于對(duì)機(jī)械通氣治療的重癥肺炎患兒的靜息能量消耗采用代謝車和H-B公式測(cè)量,以測(cè)定患兒治療所需能量,以此為基礎(chǔ)展開(kāi)治療。目的在于:①比較H-B公式與代謝車方法測(cè)定機(jī)械通氣重癥肺炎患兒能量消耗值的差異。②探討兩種能量測(cè)定方法在機(jī)械通氣重癥肺炎患兒營(yíng)養(yǎng)支持治療中的指導(dǎo)意義。方法:對(duì)2013年12月~2014年12月湖南省兒童醫(yī)院重癥醫(yī)學(xué)科室收集治療的100例上呼吸機(jī)的重癥肺炎患兒展開(kāi)研究,所有研究對(duì)象均為需要進(jìn)行機(jī)械通氣治療的患兒,采用分組的方式對(duì)患兒進(jìn)行研究調(diào)查,首先將100例患兒均予以代謝車和H-B公式計(jì)算能量消耗。再將研究對(duì)象隨機(jī)分為A、B兩組,每組各50例患兒:實(shí)驗(yàn)組:按代謝車測(cè)定靜息能量消耗進(jìn)行能量支持。對(duì)照組:按H-B公式計(jì)算能量消耗值進(jìn)行營(yíng)養(yǎng)支持。對(duì)患兒的REE值、血漿蛋白、肺功能及血?dú)夥治�、疾病預(yù)后相關(guān)指標(biāo)(ICU住院時(shí)間、死亡率、呼吸性相關(guān)肺炎的發(fā)生率、撤離呼吸機(jī)時(shí)間等)進(jìn)行觀察統(tǒng)計(jì)。并采用SPSS18.0專業(yè)統(tǒng)計(jì)學(xué)軟件系統(tǒng)對(duì)研究數(shù)據(jù)進(jìn)行分析評(píng)價(jià),計(jì)數(shù)資料采用χ2檢驗(yàn),以%表示,計(jì)量資料以x±s表示,采用t檢驗(yàn);P0.05表示差異有顯著統(tǒng)計(jì)學(xué)意義。結(jié)果:①100患兒間接測(cè)熱法在第1、3、5d測(cè)量平均值低于H-B公式組,經(jīng)統(tǒng)計(jì)學(xué)分析差異有意義(P0.05);第7d實(shí)驗(yàn)組患兒REE與對(duì)照組相近(P0.05),統(tǒng)計(jì)學(xué)無(wú)明顯差異。②從血?dú)夥治鰜?lái)看,實(shí)驗(yàn)組患兒Pa O2和BE值較治療前升高差值與對(duì)照組比較,經(jīng)統(tǒng)計(jì)學(xué)分析差異有意義(P0.05),實(shí)驗(yàn)組患兒的Pa CO2、PH、LAC、和GLU較治療前降低差值比較,經(jīng)統(tǒng)計(jì)學(xué)分析兩組治療前后血?dú)夥治鲋笜?biāo)下降幅度存在差異(P0.05)。從感染指標(biāo)來(lái)看,實(shí)驗(yàn)組患兒的CRP、PCT、WBC、LYM、NEU和血沉下降差值比較,經(jīng)統(tǒng)計(jì)學(xué)分析差異有意義(P0.05)。從血漿蛋白來(lái)看,實(shí)驗(yàn)組患兒的血漿白蛋白、血漿球蛋白和血漿前蛋白增加差值與對(duì)照組比較,經(jīng)統(tǒng)計(jì)學(xué)分析差異有意義(P0.05)。實(shí)驗(yàn)組患兒血漿總蛋白治療前后降低差值與對(duì)照組比較,經(jīng)統(tǒng)計(jì)學(xué)分析差異有意義(P0.05)。治療后實(shí)驗(yàn)組患兒的血?dú)夥治鲋笜?biāo)、感染指標(biāo)和血漿蛋白的值恢復(fù)正常的比例均高于對(duì)照組,經(jīng)統(tǒng)計(jì)學(xué)分析差異有意義(P0.05)。③實(shí)驗(yàn)組患兒入住ICU時(shí)間、撤離呼吸機(jī)時(shí)間均較對(duì)照組短,呼吸機(jī)相關(guān)性肺炎的發(fā)生率低于對(duì)照組,上述指標(biāo)比較差異顯著(P0.05)。實(shí)驗(yàn)組患兒總住院時(shí)間短于對(duì)照組,P0.05,統(tǒng)計(jì)學(xué)差異顯著。結(jié)論:①代謝車測(cè)量的REE提供的能量較H-B公式低,與傳統(tǒng)的H-B公式相比,間接能量代謝法測(cè)定的靜息能量消耗的結(jié)果更為準(zhǔn)確,更接近正常兒童。②在重癥肺炎機(jī)械通氣患兒營(yíng)養(yǎng)干預(yù)中,炎性指標(biāo)有所好轉(zhuǎn),改善疾病預(yù)后,建議使用代謝車指導(dǎo)臨床治療。
[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.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R725.6

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