中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2014年
3期
131-134
,共4页
刘朝晖%苏磊%廖银光%刘志锋%刘俊灵
劉朝暉%囌磊%廖銀光%劉誌鋒%劉俊靈
류조휘%소뢰%료은광%류지봉%류준령
目标能量%能量摄入%预后%脓毒症%静息代谢
目標能量%能量攝入%預後%膿毒癥%靜息代謝
목표능량%능량섭입%예후%농독증%정식대사
Target energy%Caloric intake%Outcome%Sepsis%Rest energy expenditure
目的 观察给脓毒症患者提供不同水平的目标能量对其预后及并发症的影响.方法 采用前瞻性随机对照单盲研究,应用间接测热法监测重症监护病房(iCU)158例脓毒症患者的静息能量消耗,将患者按随机数字表法分为3组,A、B、C组分别以静息代谢值＜90％、90％～ 110％、＞110％作为营养目标值,分析各组能量摄入、机械通气时间、院内感染发生率及28 d、60d生存率.结果入住ICU前7d每天能量摄入情况:A、B、C组能量目标值(kJ/d:7 075.0±1 046.5、5 667.8±1 908.8、4 428.8±1 377.8)、实际摄入能量(kJ/d:4 671.6±1 205.6、5655.3±1 373.0、6053.0±1 557.2)、肠内能量摄入量(kJ/d:2051.1±1046.5、3980.9±1 586.5、5 337.2±2 921.8)、平均摄入率[(66.0±15.8)％、(100.0±5.7)％、(134.0±19.7)％]两两比较差异均有统计学意义(均P＜0.05)；C组肠外能量补充量明显高于A组、B组(J/d:2 055.3±273.4比427.0±273.4、473.0±332.0,均P＜0.05)；3组间静脉葡萄糖输液所提供能量及异丙酚所供应的能量比较差异无统计学意义.B组机械通气时间短于A组和C组(d:8.4±6.3比11.0±8.2、17.8±13.0,P＞0.05和P＜0.05),ICU住院时间也短于A组和C组(d:11.0±6.4比14.9±9.6、17.8±13.0,P＞0.05和P＜0.05).A、B、C组总住院时间(d:32.0±22.5、26.8±7.0、30.4±21.4)以及院内感染发生率[91.1％(51/56)、84.0％(42/50)、90.4％(47/52)]两两比较差异均无统计学意义(均P＞0.05).生存曲线分析显示:3组28 d生存率差异无统计学意义(F=3.145,P=0.076);A组、C组60d生存率呈明显下降趋势,其中C组下降趋势更为明显(F=9.284,P=0.010).结论对脓毒症患者早期无论是高热量或是低热量提供能量,其长期预后均不利,而恰当的目标能量供应可减少并发症,提高长期生存率.
目的 觀察給膿毒癥患者提供不同水平的目標能量對其預後及併髮癥的影響.方法 採用前瞻性隨機對照單盲研究,應用間接測熱法鑑測重癥鑑護病房(iCU)158例膿毒癥患者的靜息能量消耗,將患者按隨機數字錶法分為3組,A、B、C組分彆以靜息代謝值＜90％、90％～ 110％、＞110％作為營養目標值,分析各組能量攝入、機械通氣時間、院內感染髮生率及28 d、60d生存率.結果入住ICU前7d每天能量攝入情況:A、B、C組能量目標值(kJ/d:7 075.0±1 046.5、5 667.8±1 908.8、4 428.8±1 377.8)、實際攝入能量(kJ/d:4 671.6±1 205.6、5655.3±1 373.0、6053.0±1 557.2)、腸內能量攝入量(kJ/d:2051.1±1046.5、3980.9±1 586.5、5 337.2±2 921.8)、平均攝入率[(66.0±15.8)％、(100.0±5.7)％、(134.0±19.7)％]兩兩比較差異均有統計學意義(均P＜0.05)；C組腸外能量補充量明顯高于A組、B組(J/d:2 055.3±273.4比427.0±273.4、473.0±332.0,均P＜0.05)；3組間靜脈葡萄糖輸液所提供能量及異丙酚所供應的能量比較差異無統計學意義.B組機械通氣時間短于A組和C組(d:8.4±6.3比11.0±8.2、17.8±13.0,P＞0.05和P＜0.05),ICU住院時間也短于A組和C組(d:11.0±6.4比14.9±9.6、17.8±13.0,P＞0.05和P＜0.05).A、B、C組總住院時間(d:32.0±22.5、26.8±7.0、30.4±21.4)以及院內感染髮生率[91.1％(51/56)、84.0％(42/50)、90.4％(47/52)]兩兩比較差異均無統計學意義(均P＞0.05).生存麯線分析顯示:3組28 d生存率差異無統計學意義(F=3.145,P=0.076);A組、C組60d生存率呈明顯下降趨勢,其中C組下降趨勢更為明顯(F=9.284,P=0.010).結論對膿毒癥患者早期無論是高熱量或是低熱量提供能量,其長期預後均不利,而恰噹的目標能量供應可減少併髮癥,提高長期生存率.
목적 관찰급농독증환자제공불동수평적목표능량대기예후급병발증적영향.방법 채용전첨성수궤대조단맹연구,응용간접측열법감측중증감호병방(iCU)158례농독증환자적정식능량소모,장환자안수궤수자표법분위3조,A、B、C조분별이정식대사치＜90％、90％～ 110％、＞110％작위영양목표치,분석각조능량섭입、궤계통기시간、원내감염발생솔급28 d、60d생존솔.결과입주ICU전7d매천능량섭입정황:A、B、C조능량목표치(kJ/d:7 075.0±1 046.5、5 667.8±1 908.8、4 428.8±1 377.8)、실제섭입능량(kJ/d:4 671.6±1 205.6、5655.3±1 373.0、6053.0±1 557.2)、장내능량섭입량(kJ/d:2051.1±1046.5、3980.9±1 586.5、5 337.2±2 921.8)、평균섭입솔[(66.0±15.8)％、(100.0±5.7)％、(134.0±19.7)％]량량비교차이균유통계학의의(균P＜0.05)；C조장외능량보충량명현고우A조、B조(J/d:2 055.3±273.4비427.0±273.4、473.0±332.0,균P＜0.05)；3조간정맥포도당수액소제공능량급이병분소공응적능량비교차이무통계학의의.B조궤계통기시간단우A조화C조(d:8.4±6.3비11.0±8.2、17.8±13.0,P＞0.05화P＜0.05),ICU주원시간야단우A조화C조(d:11.0±6.4비14.9±9.6、17.8±13.0,P＞0.05화P＜0.05).A、B、C조총주원시간(d:32.0±22.5、26.8±7.0、30.4±21.4)이급원내감염발생솔[91.1％(51/56)、84.0％(42/50)、90.4％(47/52)]량량비교차이균무통계학의의(균P＞0.05).생존곡선분석현시:3조28 d생존솔차이무통계학의의(F=3.145,P=0.076);A조、C조60d생존솔정명현하강추세,기중C조하강추세경위명현(F=9.284,P=0.010).결론대농독증환자조기무론시고열량혹시저열량제공능량,기장기예후균불리,이흡당적목표능량공응가감소병발증,제고장기생존솔.
Objective To observe the impact of the diverse caloric energy intake on the outcomes and occurrence rate of complications in septic patients.Methods A prospective single-blind randomized controlled trial was conducted.158 cases of septic patients in intensive care unit (ICU) were enrolled and randomly assigned to three groups according to their different target value of nutrition:group A [measurements of resting energy expenditure (MREE)＜90％],B (MREE 90％-110％) and C (MREE ＞ 110％).The caloric intake,mechanical ventilation duration (MVD),nosocomial infection rate,28-day and 60-day mortality were analyzed.Results Daily energy intake in 7 days after ICU admission was as follows:the difference in target value of nutrition(kJ/d:7 075.0 ± 1 046.5,5 667.8 ± 1 908.8,4 428.8 ± 1 377.8),calory intake (kJ/d:4 671.6 ± 1 205.6,5 655.3 ± 1 373.0,6 053.0 ± 1 557.2),enteral nutrition value (kJ/d:2 051.1 ± 1 046.5,3 980.9 ± 1 586.5,5 337.1 ±2 921.8) and average intake rate [(66.0 ± 15.8)％,(100.0 ± 5.7)％,(134.0 ± 19.7)％],and they were statistically significant difference among A,B,C groups (all P＜0.05).The parenteral nutrition in group C were much higher than that in group A and group B (kJ/d:2 055.3 ± 273.4vs.427.0 ± 273.4,473.0 ± 332.0,both P＜0.05).The calories provided by glucose and diprivan were similar among three groups.The MVD and ICU stay were shorter in group B than that in groups A and C [MVD (days):8.4 ± 6.3 vs.11.0 ± 8.2,17.8 ± 13.0,P＞ 0.05 and P＜ 0.05 ; ICU stay (days):11.0 ± 6.4 vs.14.9 ± 9.6,17.8 ± 13.0,respectively,P＞0.05 and P＜0.05].The total hospital stay (days:32.0 ± 22.5,26.8 ± 7.0,30.4 ± 21.4) and nosocomial infection rate [91.1％ (51/56),84.0％ (42/50),90.4％ (47/52)] were similar among A,B,C groups (all P＞0.05).There was no difference in survival rate at 28 days among three groups as shown by the Kaplan-Meier survival curve (F=3.145,P=0.076).The survival rate at 60 days showed a tendency of lowering in groups A and C,especially in group C (F=9.284,P=0.010).Conclusion Both higher and lower caloric energy intake may be associated with an adverse impact,but appropriate caloric intake would improve the outcome and reduce the complication rate in septic patients.
