改良HB系数法指导的营养支持疗法对重症颅脑损伤患者预后的影响

Effect of nutritional target support therapy with modified HB coefficient on the prognosis of patients with severe craniocerebral injury

目的探讨改良Harris-Benedict(HB)系数法指导的营养支持治疗对重症颅脑损伤(TBI)患者预后的影响。方法选择2019年9月至2022年6月南京医科大学第一附属医院神经外科、南京医科大学第四附属医院及南京医科大学附属鼓楼医院重症监护病房颅脑损伤的患者87例,并以间接能量测定(IC)法及HB法监测患者的静息能量消耗(REE),并分析两种方法的差异性及相关性,得出两者的线性回归方程(即改良HB系数法公式)。进一步对得到的改良HB系数法公式进行验证,另选取南京医科大学第四附属医院2022年6月至9月入院的40例重型颅脑损伤患者按照随机数字表法分为IC组和改良HB系数法组,比较两组预后指标。结果颅脑损伤患者在营养支持治疗的2周内分别使用IC及HB系数法测算患者REE各316次,经比较IC所得REE数值明显高于HB系数法(P<0.05);基于IC法改良的HB系数回归方程式为:Y=0.68X+767.67(单位:kJ/d,X为重症颅脑损伤患者HB系数法计算的REE)。改良HB系数法组与IC法组预后指标比较差异无统计学意义(P>0.05)。结论对于重度TBI患者,HB系数法明显低估了患者的能量消耗,通过IC法改良的HB系数法能够较准确地估算重症颅脑损伤患者的能量消耗,为临床提供准确简便的营养支持指导。

Objective To investigate the effect of nutritional target support therapy with modified Harris-Benedict(HB)coefficient on the prognosis of patients with severe craniocerebral injury(TBI).Methods A total of 87 severe TBI patients admitted to the Department of Neurosurgery,the First Affiliated Hospital of Nanjing Medical University,the Intensive Care Unit the Fourth Affiliated Hospital of Nanjing Medical University and the Gulou Hospital of Nanjing Medical University from September 2019 to June 2022 were selected.Resting energy expenditure(REE)was measured by respiratory indirect calorimetry(IC)method and HB method of nutritional support.The difference and correlation between the two methods were analyzed,and the linear regression equation of the two methods was obtained(namely improved HB coefficient method formula).In addition,40 severe TBI patients admitted to the Fourth Affiliated Hospital of Nanjing Medical University from June 2022 to September were selected and they were divided into IC group and modified HB coefficient method group according to the random number table method,and the prognostic indicators of the two groups were compared.Results The REE values of severe TBI patients were measured by IC and HB coefficient method 316 times respectively within two weeks of nutritional support treatment.The REE values obtained by IC method were significantly higher than those obtained by HB coefficient method(P<0.05);the modified HB coefficient regression equation based on IC method was Y=0.68X+767.67(unit:kJ/d,X was the REE calculated by HB coefficient method of severe TBI patients).There was no significant difference in the the modified HB coefficient method group and IC method group(P>0.05).Conclusion The HB coefficient method significantly underestimated the energy expenditure of severe TBI patients within two weeks of the course of the disease.The modified HB coefficient method by IC method can more accurately estimate the energy expenditure of severe TBI patients,and provide accurate and simple nutritional support for clinical practice.