能量代谢评价重症患者营养状态的临床意义

Influence of energy metabolism evaluation on nutritional status of patients with severe diseases

目的探讨能量代谢评价危重患者营养状态的临床意义。方法入住ICU APACHEⅡ评分>15分危重患者60例,参照指南25 kcal/(kg·d)提供热卡,糖脂比为1:1,热氮比为1:100。按照随机数字表法分为2组,能量监测组(n=30)使用"间接能量测热法"测量患者能量消耗,监测静脉营养(total parenteral nutrition,TPN)24 h后能量消耗(energy consumption,EC)及呼吸商(respiratory quotient,RQ),并根据EC、RQ调整热卡供给量及糖脂比。同时检测前白蛋白及血糖。对照组(n=30)不做能量代谢监测。结果能量监测组TPN 7 d后白蛋白、前白蛋白均明显高于能量代谢监测前(P<0.01),而对照组TPN 7 d后白蛋白、前白蛋白与TPN前比较差异不显著(P>0.05)。能量监测组营养支持3 d后能量供给、RQ、糖脂比明显高于早期TPN 24 h后(P<0.05)。能量监测组营养支持后每日平均血糖值高于对照组,但差异无统计学意义(P>0.05),每日胰岛素用量明显高于对照组(P<0.05)。结论危重患者存在热卡及糖供应不足的情况,葡萄糖实际需要量可能比预测的要多,有条件时应进行能量代谢测量,及时补充营养。

Objective To investigate the clinical significance of energy metabolism evaluation on nutritional status of patients with severe diseases. Methods 60 ICU patients with severe diseases and APACHII[ score〉15 were provided 25 kcal/（kg.d） according to Guide, glyco vs lipids 1：1, energy-nitrogen ratio 1：100. 30 patients were randomly extracted for TPN and energy consumption were detected by indirect calorimetric measurement after 24 h and 72 h of TPN, and total caloric consumption of 24 h and respiratory quotient were evaluated for adjusting the supply lipid ratio. Pre-albumin and blood sugar glucose were detected. Another 30 patients were de amounts of calories and glycol- tected as the control group, and they were not given energy consumption monitoring. Results The Pre-albumin and, albumin of experimental group after 7 d of TPN were significantly higher than TPN immediately （P〈0.01）, but the control group had no difference （P 〉0.05）. The energy supply, respiratory quotient, glycolipids ratio of experimental group TPN 3 d were significantly higher than TPN 24 h （P〈0.05）, and daily average blood glucose level in the experimental group after nutritional support were higher than nutritional support before, but the difference was not statistically significant （P〉0.05）; the daily insulin dose of experimental group was significantly higher than the control group. Conclusion Patients with severe diseases have shortage of energy and glucose supply, and they actually need more glucose requirements than predicted. Therefore, energy metabolism should be measured for nutritional supplements when needed