發(fā)布時間：2018-01-03 23:10

  本文關(guān)鍵詞：間接測熱法對重癥患者能量代謝的評定　出處：《寧夏醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 間接測熱法 靜息能量消耗 危重癥 機械通氣

【摘要】：目的采用間接測熱法測量危重癥期間機械通氣患者的靜息能量消耗（REE，kcal/d），，評估其靜息能量消耗（REE，kcal/d）水平，探討重癥病人實際能量消耗狀況及重癥狀態(tài)下營養(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機械通氣患者為研究對象，評估患者的危重病程度(APACHEⅡ評分)及營養(yǎng)風(fēng)險評分（NRS2002）。采用間接測熱法對患者的靜息能量消耗(mREE,kcal/d)進行測定，將測量結(jié)果與臨床醫(yī)師根據(jù)患者病情所給的實際營養(yǎng)供給量（pREE,kcal/d）相對比；按照病程不同階段、危重癥不同程度，及有無全身炎癥反應(yīng)（SIRS）分組進行比較；根據(jù)能量缺失程度將其分為4組，比較4組間APACHEⅡ評分、住院時間及死亡率的關(guān)系；并采用多元回歸對患者的一般信息和生化指標(biāo)與靜息能量消耗進行相關(guān)性分析。 結(jié)果共納入重癥患者60例。（1）重癥患者的實際營養(yǎng)供給量（pREE,1474.3±488.9kcal/d）整體水平明顯低于間接測熱法測量的靜息能量消耗(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)計學(xué)意義（p0.001）；相對穩(wěn)定期組患者兩者之間差異無統(tǒng)計意義；（3）各組患者的pREE與mREE分別比較，APACHE II評分≥15組（1366.1±550.9VS1785.6±373.7kcal/d）、APACHE II評分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)計學(xué)差異（P0.05）；（4）能量虧損較嚴重組的平均APACHEⅡ評分增高、ICU住院日延長、28d死亡率增加，與相對能量平衡組比較，統(tǒng)計學(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評分、血壓、呼吸頻率、呼吸商等指標(biāo)無相關(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，并且住院時間相對延長，死亡率增高；（2）臨床醫(yī)師根據(jù)患者病情所給的營養(yǎng)供給量的整體水平明顯低于間接測熱法監(jiān)測所得的靜息能量消耗，尤其以急性期患者為主;(3)床旁即時間接能量測定法對臨床營養(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)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R459.7

【相似文獻】

相關(guān)期刊論文 前10條

1 饒志勇;伍曉汀;胡雯;;健康成人公式預(yù)測法與間接測熱法測定靜息能量消耗的差異[J];中國組織工程研究與臨床康復(fù);2010年46期

2 張軍;曹相原;;間接測熱法測量的靜息能量消耗對重癥患者的營養(yǎng)支持作用[J];藥物與人;2014年04期

3 劉朝暉;劉俊靈;吳金春;廖銀光;;腦傷患者間接測熱法與傳統(tǒng)計算法能量消耗比較[J];創(chuàng)傷外科雜志;2012年06期

4 孫士春;KROGH代謝性能評估及誤差分析[J];菏澤醫(yī)專學(xué)報;1992年01期

5 張軍;曹相原;;間接能量測定法對重癥患者能量代謝的研究[J];寧夏醫(yī)學(xué)雜志;2014年08期

6 陳志新,曾因明,劉功儉;間接測熱法和反向Fick氏法測定心臟手術(shù)病人術(shù)后氧耗量的比較[J];中華麻醉學(xué)雜志;2002年11期

7 ;[J];;年期

8 ;[J];;年期

9 ;[J];;年期

10 ;[J];;年期

相關(guān)會議論文 前1條

1 肖桂珍;蘇磊;段鵬凱;王欽先;黃英;;間接測熱法與常用的能量估算法用于ICU病人的比較[A];中華醫(yī)學(xué)會急診醫(yī)學(xué)分會第十三次全國急診醫(yī)學(xué)學(xué)術(shù)年會大會論文集[C];2010年

相關(guān)碩士學(xué)位論文 前1條

1 張軍;間接測熱法對重癥患者能量代謝的評定[D];寧夏醫(yī)科大學(xué);2014年

本文編號：1375996