严重脓毒症合并急性肾损伤患儿的能量代谢研究

Study on energy metabolism in children with severe sepsis and acute renal injury

目的探讨间接能量测定法(代谢车)与临床常用预测公式对脓毒症患儿合并急性肾损伤(AKI)的能量消耗评估差异,阐明该类患儿能量代谢特征,并深入探讨影响脓毒症合并AKI患儿静息能量消耗的相关因素及间接能量代谢法在脓毒症合并AKI患儿中的临床应用。方法选取2013年12月-2014年12月在湖南省儿童医院PICU确诊的68例脓毒症患儿为研究对象,根据是否合并急性肾损伤分为急性肾损伤组(AKI组,34例)和非急性损伤组(非AKI组,34例),其中AKI组患儿根据是否采用持续性肾脏替代治疗(CRRT)分为CRRT组和非CRRT组。分别采用间接能量测定法(代谢车)和临床儿科常用预测公式Harris-Benedict(H-B)测定上述患儿静息能量消耗情况,并对患儿的能量消耗测定值与预测公式计算值进行相关性分析,对比分析性别、是否合并AKI及是否采用CRRT对患儿的实际能量消耗是否产生影响,并观察患儿的生命体征指标如静息能量代谢时肛温、心率、呼吸频率、生化检测指标、炎性因子检测指标、血气分析指标患儿全天能量供给与静息能量消耗和呼吸商的相关性。结果两组患儿一般资料比较,差异无统计学意义(P>0.05)。AKI患儿与非AKI患儿、CRRT患儿与非CRRT患儿的生命体征与生化检测指标比较,差异有统计学意义(P<0.05)。AKI患儿静息能量消耗测定值与H-B公式预计值之间及是否采用CRRT的AKI患儿静息能量消耗比较,差异有统计学意义(P<0.05)。H-B公式预计值与测定值比较,差异有统计学意义(P<0.05)。不同性别、不同时期AKI患儿实际能量消耗比较,差异无统计学意义(P>0.05);而是否采用CRRT的AKI患儿实际能量消耗比较,差异有统计学意义(P<0.05)。结论持续性肾脏替代治疗能够显著改善AKI患儿的能量代谢障碍,采用公式法测得的AKI患儿静息能量消耗预计值与采用间接能量测定法(代谢车)测定值之间存在较大差异,以预测公式给予相应的营养支持可能造成营养不良,临床上应按照间接能量测定法测得的实际能量消耗值供能;而AKI患儿中CRRT组与非CRRT组患儿静息能量消耗值存在显著差异,但AKI不同时期(风险期、损伤期、衰竭期)的能量代谢测定差异比较由于临床例数过少,需进一步临床研究予以证实。

Objective To investigate the difference between indirect energy measurement and clinical prediction formula of sepsis children with acute kidney injury(AKI)energy consumption,clarify these patients energy metabolism characteristics,To explore the related factors affecting the resting energy consumption in children with sepsis complicated with AKI,and the clinical application of indirect energy metabolism in children in sepsis complicated with AKI.Methods Select 68 sepsis patients with AKI as the research objects in December 2013-December 2014 in Hunan Children's Hospital PICU.Patients were divided into the acute kidney injury group(34 cases)and the non-acute kidney injury group.Children in the AKI group were divided into the CRRT group and the non-CRRT group.Indirect energy measurement(metabolic vehicle)and harris-benedict(H-B)formula were used respectively to determine the resting energy consumption of the patients.Calculate the value of correlation analysis betweenmeasurements and prediction of energy consumption for these children,,analyse gender,AKI and CRRT impact on energy consumption.To observe the correlation between the indexes of vital signs such as anal temperature,heart rate,respiratory rate,biochemical index,inflammatory factor,blood gas analysis and resting energy consumption during resting energy metabolism.Results Two groups of children with general data comparison,there was no statistically significant difference(P>0.05).There were statistically significant differences in vital signs and biochemical indicators between AKI and non-AKI children,and between CRRT and non-CRRT children(P<0.05).Children with AKI resting energy expenditure between measured value and HB formula expected difference was statistically significant(P<0.05).CRRT and non-CRRT children was statistically significant(P<0.05).there was no statistically significant difference(P>0.05)in different gender,different period of AKI children energy consumption comparison,Whether to adopt the CRRT in AKI children with actual energy consumption comparison,the difference was statistically significant(P<0.05).Conclusion CRRT can significantly improve the energy metabolism disorders of AKI children.There is a big difference between the estimated resting energy consumption of AKI children measured by formula method and by indirect energy method(metabolic vehicle).Nutritional support with predictive formulas may result in malnutrition.The actual energy consumption measured by indirect energy measurement should be supplied clinically.There were significant differences in resting energy consumption between CRRT group and non-CRRT group.Because the number of patients is too small,the difference in energy metabolism measurement of AKI in different stages(risk stage,injury stage and failure stage)needs to be confirmed by further clinical studies.