【摘要】 目的对重症患者疾病早期应激程度进行分级,同时采用间接测热法(indirect calorimetry,IC)测定患者能量需求,从而指导重症患者应激早期的能量供给。方法收集了2015-01~2015-12入住河北省人民医院重症医学科进行有创机械通气的重症患者125例,根据入选和排除标准对所收集患者进行筛选。引用应激指数的概念,按应激指数的不同分为轻度应激(n=21)、中度应激(n=100)、重度应激(n=4)三组。然后对每位受试者采用IC测定机体的能量需求,分析各组间能量需求的差异,并探讨不同能量供给对预后的影响。结果本试验共纳入125例患者,轻度、中度、重度应激组患者平均能量需求分别为(16.34±2.32)kcal/(kg·d)、(23.34±3.83)kcal/(kg·d)、(32.29±8.96)kcal/(kg·d),各组间差异有统计学意义(P<0.001);轻、中、重度三组能量供给量分别为(12.51±6.69)kcal/(kg·d)、(17.38±10.07)kcal/(kg·d)、(20.88±8.93)kcal/(kg·d),分别与各组能量需求量相比,轻度及中度应激组患者能量供给低于机体能量需求(P=0.021,P<0.001);而重度应激组能量需求与能量供给之间差异无统计学意义(P>0.05);应激程度不同的三组患者机械通气时间及住ICU时间差异均无统计学意义(P=0.18,P=0.78)。结论重症患者疾病早期不同应激程度下机体能量需求是不同的;轻度应激状态下低热卡喂养不利于改善重症患者的临床预后。更多还原

【Abstract】 Objective To classify the stress degree of critically ill patients during early disease period and measure the energy requirement of these patients by indirect calorimetry,in order to guide the nutrition support in critically ill patients with different stress grade.Methods We collected the study population who were stayed in intensive care unit of Hebei General Hospital from January 2015 to December 2015.The patients who met the enrollment and exclusion criteria were selected.The study established the stress index of all patients.According to the stress index,all subjects were divided into mild stress,moderate stress and severe stress groups.Analysis the difference of energy requirement and explore the relationship between stress grade and nutrition support.Results A total of 125 patients were enrolled in this study.The average energy requirement of three groups were significantly different(P < 0.001);respectively were(16.34±2.32) kcal/(kg·d) and(23.34±3.83)kcal/(kg·d),(32.29±8.96)kcal/(kg·d).Compared with the energy requirement,the energy supply is lower in groups with mild and moderate stress and energy supply have no significantly difference in severe stress group.The length of ventilation and ICU stay were no difference(P = 0.18.P = 0.78).Conclusion The energy expenditure of critical illness who with different stress grade is variance.Low caloric diet in critically ill patients with moderate stress is disadvantageous to improve clinical outcomes.更多还原