静息能量代谢测定对腹部外科严重脓毒症患者预后评估的价值分析

The value of resting energy expenditure in the prognosis of patients with severe sepsis in abdominal surgery

目的:探究静息能量代谢测定对腹部外科严重脓毒症患者预后评估的价值。方法:选取2018-02-2019-11期间民航总医院外科重症监护病房(SICU)收治的腹部外科严重脓毒症患者38例,分析间接能量测定法(IC法)计算的静息能量消耗值(REE)与H-B公式法、体重法计算的REE值的差异,依据急性生理与慢性健康状况评估Ⅱ(APACHEⅡ)评分和序贯器官功能衰竭评估(SOFA)评分分组,评价病情不同严重程度患者REE值的差异,并分析REE值与预后的相关性。结果:38例患者经IC法测定203次,呼吸商(RQ)在非正常范围内的患者构成比为42.36%,处于非正常代谢水平的患者构成比较高;IC法在第1天、第3天、第5天测得的REE值低于H-B法,高于体重法,且差异均有统计学意义(P<0.05);APACHEⅡ评分≤15分与>15分的患者REE值比较差异无统计学意义(P>0.05),SOFA评分≤5分患者REE值低于>5分的患者,差异有统计学意义(P<0.05);REE值与SOFA评分呈负相关(r=-0.378,P<0.05);REE值与APACHEⅡ评分无明显相关性(P>0.05)。结论:H-B法与体重法测量的REE值与IC法相比差异较大,临床上应按照IC法测得的REE值为患者提供营养支持,REE值与SOFA评分具有一定相关性,因此临床营养支持方面应充分考虑患者脏器功能状况,避免因营养过剩或营养不良加重脏器功能负担,以改善预后。

Objective: To explore the value of resting energy expenditure in the prognosis of patients with severe sepsis in abdominal surgery. Method: From February 2018 to November 2019, 38 patients with severe sepsis in abdominal surgery were selected from surgical intensive care unit(SICU), the differences between the rest energy expenditure(REE) calculated by indirect energy measurement(IC) and that calculated by H-B formula, body weight method were analyzed, according to the acute physiological and chronic health evaluation Ⅱ(APACHE Ⅱ) score and sequential organ failure assessment(SOFA) score, the patients were divided into different groups. The difference of REE value in patients with different severity was evaluated, and the correlation between REE value and prognosis was analyzed. Result: Thirty-eight patients were measured 203 times by IC method, the proportion of patients with abnormal respiratory quotient(RQ) was 42.36%, and the proportion of patients with abnormal metabolism level was significantly high in the sample;the REE values measured by IC method on the first day, the third day and the fifth day were lower than those measured by H-B method and higher than those measured by body weight method, the differences were statistically significant(P<0.05);there was no significant difference in REE value between patients with APACHE Ⅱ score ≤ 15 and patients with APACHE Ⅱ score>15(P>0.05);the REE value of patients with SOFA score ≤ 5 was lower than that of patients with SOFA score>5, and the difference was statistically significant(P<0.05);there was a negative correlation between REE value and SOFA score(r=-0.378, P<0.05);and there was no significant correlation between REE value and APACHE Ⅱ score(P>0.05). Conclusion: The REE value measured by H-B method and body weight method is quite different from that measured by IC method. Clinically, the REE value measured by IC method should be used to guide providing nutritional support for patients. The REE value has a certain correlation with the SOFA score. Therefore, in terms of clinical nutritional support, the organ function of patients should be fully considered in order to avoid aggravating the organ function burden due to overnutrition or malnutrition, so as to improve the prognosis.