严重腹腔感染的肠瘘病人能量代谢的连续性变化规律

Sequential changes of energy expenditure in gastrointestinal fistula patients complicated severe abdominal sepsis

目的:了解肠瘘合并严重腹腔感染病人能量代谢的连续性变化规律。方法:对合并严重腹腔感染的36例肠瘘病人,根据预后将其分为存活(SG)组和死亡(DG)组,连续观察病人的疾病危重度评分、能量代谢等指标。结果:两组病人治疗前静息能量消耗(REE)、C反应蛋白(CRP)和危重度评分均较高,而且治疗后DG组持续处于高水平。两组病人实际测量的REE显著高于通过Harris-Bened ict公式预测的BEE值(P<0.01)。在治疗后,SG组病人的REE逐步下降,于第5天即有显著下降(P<0.01),但仍然显著高于Harris-Bened ict公式预测的BEE值(P<0.01),直到第13天,实测的REE才回复至正常水平(P>0.05)。SG病人的CRP水平、APACHE-Ⅱ评分、SS评分均于第5天显著下降(P<0.01)。结论:控制感染可以显著降低肠瘘病人的REE、CRP、危重度评分,但REE、CRP、危重度评分持续升高提示病人预后不佳。

Objective： To investigate sequential changes of energy expenditure in gastrointestinal fistula patients with severe sepsis. Methods： Thirty six gastrointestinal fistula patients were enrolled in this study. Based on outcomes, these patients were divided into two groups： survival group （SG） and dead group （DG）. Acute Physiology and Chronic Health Evaluation （APACHE） Ⅱ score, sepsis score, Creactive protein and energy expenditure were detected. Results： Twenty six patients survived, and ten patients died. APACHE-Ⅱ score, sepsis score, C-reactive protein and energy expenditure in both groups were increased before treatment started, and remained elevated throughout the study period in DG. REE descended significantly 5 d after treatment（ P 〈 0.01 ）, but still exceeded predicted value （P 〈 0.01 ）, Meanwhile APACHE-Ⅱ scoring, sepsis score and CRP descended significantly（P 〈 0.01 ）. REE reached to normal range 13 days after the treatment. Conclusion： Treatments of controling sepsis significantly decreased APACHE-Ⅱ score, sepsis score, CRP and REE. Continued high APACHE-Ⅱ score, sepsis score, CRP and REE may clue to bad prognosis.