基于不同能量估算法的营养方案对急性重症缺血性卒中能量代谢的影响

Effects of Nutrition Regimen on Energy Metabolism in Acute Severe Ischemic Stroke Patients Based on Different Energy Estimation Method

目的比较不同能量评估法制订的营养方案在急性重症缺血性卒中治疗中的差异。方法前瞻性连续纳入2016年7月-2018年1月入住内蒙古自治区人民医院神经内科重症监护病房的急性重症缺血性卒中患者,根据随机数字法分成经验组、公式组及间接能量测定组,分别采用经验能量估算法、Harris-Benedict校正公式及间接能量测定法测定的日需静息能量代谢值(resting energy expenditure,REE)进行营养支持治疗。观察三组患者营养支持治疗前及治疗后7 d、14 d的上臂肌肉围度、腰围、淋巴细胞计数、前白蛋白、血清白蛋白及血红蛋白水平。结果最终纳入90例患者,平均年龄71±8岁,男性51例(56.67%),每组各30例。治疗前三组基线资料及营养指标差异均无统计学意义。治疗7 d淋巴细胞计数,以及治疗14 d上臂肌肉围度、血清前白蛋白及白蛋白,三组间差异均具有统计学意义;进一步两两比较,治疗7 d淋巴细胞计数和治疗14 d血清白蛋白水平在各组间差异均具有统计学意义,间接能量测定组高于公式组和经验组。结论间接能量测定法能更准确地评估急性重症缺血性卒中患者的能量需求,制订的营养方案能更好地改善患者的营养指标。

Objective To compare the differences of nutrition regimens developed by different energy assessment methods in the treatment of acute severe ischemic stroke.Methods This prospective study enrolled consecutive patients with acute severe ischemic stroke admitted to Neurological Intensive Care Unit of the People's Hospital of Inner Mongolia Autonomous Region from July 2016 to January 2018.According to the random number method,all patients were divided into three groups:experience group,formula group and indirect energy measurement group.All the patients in the three groups were given nutritional support according to the daily resting energy expenditure requirement,which were measured by empirical energy estimation method,Harris-Benedict correction formula and indirect energy measurement method,respectively.The upper arm muscle circumference and waist circumference,lymphocyte count,serum pre-albumin,albumin and hemoglobin level were measured before nutrition support and at day 7,14 after nutrition support.Results A total of 90 patients were included in the final analysis,with an average age of 71±8 years and 51(56.67%)males,and 30 cases in each group.Difference in all the nutrition indicators among the three groups were not all statistically significant before nutrition support;there were statistical differences in lymphocyte count at day 7 after nutrition support and upper arm muscle circumference,serum prealbumin and albumin level at day 14 after nutrition support among the three groups;further pairwise comparison results as follows:lymphocyte counts at day 7 and serum albumin level at day 14 after nutrition support in indirect energy measurement group were highest,and that in formula group were higher than experience group,and the differences were all statistically significant.Conclusions Indirect energy measurement can more accurately assess the energy requirements for patients with acute severe ischemic stroke,and the nutrition regimen made by which can better improve the nutritional status of the patients.