不同热能PN对老年全身炎症反应综合征的治疗研究

The efficacy of parenteral nutrition with different energy for systemic inflammatory response syndrome(SIRS) in the aged

目的 :评估应用胃肠外营养支持 (PN)治疗老年全身炎症反应综合征 (SIRS)危重患者时不同热能摄入的有效性和安全性。方法 :30例老年SIRS危重患者随机分为低热能组和高热能组各 15例 ,分别按 10 5KJ·kg- 1 ·d- 1 和 146KJ·kg- 1 ·d- 1的热能供应量进行PN连续 6d;对照分析两组蛋白质、糖、脂代谢及动脉血气的变化 ;并以急性生理和慢性健康评分系统(APACHEⅡ)评估病情严重程度的变化。结果 :二组在改善机体蛋白及氮平衡方面效果相同 ;低热能组的空腹血糖、甘油三酯水平不变 ,而高热能组显著升高 (P <0 .0 5 ) ;低热能组纠正PaO2 和降低APACHEⅡ评分均优于高热能组 (P <0 .0 5 )。结论 :应用PN治疗病情危重的老年SIRS时以 10 5KJ·kg- 1 ·d- 1

To evaluate the efficacy and safety of parenteral nutrition(PN) with lower or higher energy for treating systemic inflammatory response syndrome(SIRS) in the aged, thirty old SIRS critically ill patients were involved in a randomized control clinical trial. Fifteen cases were treated by PN with lower energy(105?KJ·kg -1 ·d -1 ), and another fifteen cases with higher energy(146?KJ·kg -1 ·d -1 ) for 6 days. The data about metabolisms of protein, glucose and fat, blood gas analysis, acute physiology and chronic heatlh evaluation(APACHE Ⅱ) were analysed. The results showed that: ① The effects of 105?KJ·kg -1 ·d -1 PN in increasing organism protein and maintaining nitrogen balance were the same as those of 146?KJ·kg -1 ·d -1 PN. ② The levels of fast blood sugar and triglyceride maintained unchanged in 105?KJ·kg -1 ·d -1 PN group, while they increased significantly in 146?KJ·kg -1 ·d -1 PN group(P<0.05). ③ PaO 2 was raised greatly in 105?KJ·kg -1 ·d -1 PN group, while not in 146?KJ·kg -1 ·d -1 PN group. ④ 105?KJ·kg -1 ·d -1 PN and 146?KJ·kg -1 ·d -1 PN decreased APACHE Ⅱ(P<0.05), but the efficiency of 105?KJ·kg -1 ·d -1 PN was better than that of 146?KJ·kg -1 ·d -1 PN(P<0.05). We conclude that PN with 105?KJ·kg -1 ·d -1 energy intake is more effective and safer for treating SIRS than that with 146?KJ·kg -1 ·d -1 in the aged. [