间接能量测定系统在重型颅脑损伤治疗中的应用及其临床意义

Clinical application and significance of the critical care management system in the treatment of patients with severe traumatic brain injury

目的探讨间接能量测定系统(简称:代谢车)在重型颅脑损伤患者治疗中的应用及其临床意义。方法 85例重型颅脑损伤患者,按照随机数字表法分为代谢车组43例与常规组(HB公式组)42例,分别应用代谢车与Harris-Benedict公式法测算出患者所需的静息能量消耗值(REE),指导营养供给,将能量消耗数据转换成代谢趋势图,并进行分析比较。结果两组患者入院第7天与第14天的营养指标组内比较差异有统计学意义(P<0.05),组间比较差异无统计学意义(P>0.05);代谢车组入院后第1、7、14天的REE值明显低于HB公式组,差异有统计学意义(P<0.05);在第3天时两组所测值相近且差异无统计学意义(P>0.05)。代谢趋势图示代谢车组日需能量总体上低于HB公式组(P<0.05);死亡患者死亡前3天的能量消耗急聚下降。结论代谢车测定重型颅脑损伤患者的REE值明显低于HB公式法测算值,所绘制的代谢变化趋势图可以直观反映重型颅脑损伤患者伤后的代谢变化,对病情的判断有一定帮助;根据代谢车测定的REE值提供能量更准确且节约营养费用。

Objective To explore the clinical application and significance of the critical care management system （ metabolic vehicle ） in the treatment of patients with severe traumatic brain injury .Methods From December 2013 to June 2014 ,85 patients with severe traumatic brain injury were enrolled in and randomly divided into the group （43 cases）and Harris-Benedict（HB）formula group （42 cases）.The resting energy expenditure （REE）of the patients was calculated by using metabolism vehicle and Harris-Benedict for-mula method,respectively,to guide nutrient supply.The energy consumption data was transformed into metabolic trend diagram and compared between the two groups .Results There was a significant difference in nutritive index within the groups on the 7th day and the 14th day after admission（P 〈0.05）but no significant difference between the two groups .The REE values in the metabolic vehicle group on the 1st,7th and 14th days after admission were significantly lower than that in the HB formula group （P〈0.05）.However,the values on the 3rd day were not significantly between the two groups .There was a significant difference in the metabolic trends diagram between the two groups and the energy consumption in the metabolic vehicle group was generally lower than that in the HB formula group.The energy consumption dropped precipitously on the 3 days before the death .Conclusion The REE values of patients with se-vere traumatic brain injury measured by metabolism vehicle are significantly lower than that calculated with the HB formula .The dia-gram of metabolic vehicle can accurately reflect the metabolic changes of the patients that can help to judge the disease .In addition ,it may provide more accurate energy and cut down the cost of nutrition according the REE value calculated by the metabolism vehicle .