中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2014年
5期
292-295
,共4页
陈建丽%徐艳霞%周茉%唐熔%凌萍%周麟永
陳建麗%徐豔霞%週茉%唐鎔%凌萍%週麟永
진건려%서염하%주말%당용%릉평%주린영
严重脓毒症%视黄醇结合蛋白%血清前白蛋白%谷氨酰胺%营养支持%儿童
嚴重膿毒癥%視黃醇結閤蛋白%血清前白蛋白%穀氨酰胺%營養支持%兒童
엄중농독증%시황순결합단백%혈청전백단백%곡안선알%영양지지%인동
Severe sepsis%Retinol conjugated protein%Pre-albumin%Glutamine%Nutrition support%Children
目的 探讨严重脓毒症患儿营养支持治疗方法.方法 198例严重脓毒症患儿进行生化指标、营养指标、血气分析、血常规以及入院后24 h尿尿素氮等检测,根据患儿机体状况给予相应的营养支持,选择肠内营养或肠外营养,或同时给予肠内营养和肠外营养,肠外营养组又分谷氨酰胺(glutamine,Gln)组和非Gln组.监测严重脓毒症存活患儿及死亡患儿的营养指标及代谢指标,包括血糖、C反应蛋白、血红蛋白(Hb)、pH值、血钠、血钾、谷丙转氨酶、血尿素氮、血肌酐、血乳酸,乳酸清除率、血甘油三酯、血总胆固醇、血清前白蛋白(pre-albumin,PA)、视黄醇结合蛋白(retinal-binding protein,RBP)、血清白蛋白(albumin,ALB)、24h尿尿素氮.对存活及死亡患儿营养支持前0d及营养支持第3天、第7天的摄入热卡进行比较.对Gln组和非Gln组患儿的免疫球蛋白指标进行比较.结果 存活组患儿营养指标均较死亡组高[PA(130.0±30.0)mg/L vs (50.8±20.5)mg/L,RBP(22.3±10.3) mg/L vs (15.7±6.7) mg/L,ALB(35.3 ±8.1) g/L vs (28.7 ±6.2)g/L,Hb(113.2±27.7) g/L vs (95.3±10.6) g/L,IgA(0.40±0.03) g/Lvs (0.40±0.03)g/L,IgM(0.52±0.18) g/L vs (0.49±0.03) g/L] (P ＜0.05).存活组患儿营养支持第3天和第7天的热卡分别为(50.32 ±2.76) kcal/(kg·d)和(65.70±3.25) kcal/(kg·d),明显高于死亡组(32.54±1.72) kcal/(kg·d)和(46.12±1.08) kcal/(kg·d) (P ＜0.05).存活组患儿Gln组免疫球蛋白明显高于非Gln组[IgG(4.93 ±2.1)g/L vs(4.01±1.03) g/L,IgA(0.31±0.07) g/L vs(0.19 ±0.03) g/L,IgM(0.52±0.08) g/L vs (0.32 ±0.10) g/L] (P ＜0.05),负氮平衡状况也好于非Gln组[(-2.5±1.4)g/d vs(-5.3±1.3)g/d],差异有统计学意义(P＜0.05).结论 严重脓毒症患儿疾病早期表现为代谢率明显升高,能量消耗明显增加,蛋白分解利用大于合成,呈现明显负氮平衡,病情越重,机体代谢指标、营养指标、免疫球蛋白等越低.对患儿进行PN时加用Gln很有必要.
目的 探討嚴重膿毒癥患兒營養支持治療方法.方法 198例嚴重膿毒癥患兒進行生化指標、營養指標、血氣分析、血常規以及入院後24 h尿尿素氮等檢測,根據患兒機體狀況給予相應的營養支持,選擇腸內營養或腸外營養,或同時給予腸內營養和腸外營養,腸外營養組又分穀氨酰胺(glutamine,Gln)組和非Gln組.鑑測嚴重膿毒癥存活患兒及死亡患兒的營養指標及代謝指標,包括血糖、C反應蛋白、血紅蛋白(Hb)、pH值、血鈉、血鉀、穀丙轉氨酶、血尿素氮、血肌酐、血乳痠,乳痠清除率、血甘油三酯、血總膽固醇、血清前白蛋白(pre-albumin,PA)、視黃醇結閤蛋白(retinal-binding protein,RBP)、血清白蛋白(albumin,ALB)、24h尿尿素氮.對存活及死亡患兒營養支持前0d及營養支持第3天、第7天的攝入熱卡進行比較.對Gln組和非Gln組患兒的免疫毬蛋白指標進行比較.結果 存活組患兒營養指標均較死亡組高[PA(130.0±30.0)mg/L vs (50.8±20.5)mg/L,RBP(22.3±10.3) mg/L vs (15.7±6.7) mg/L,ALB(35.3 ±8.1) g/L vs (28.7 ±6.2)g/L,Hb(113.2±27.7) g/L vs (95.3±10.6) g/L,IgA(0.40±0.03) g/Lvs (0.40±0.03)g/L,IgM(0.52±0.18) g/L vs (0.49±0.03) g/L] (P ＜0.05).存活組患兒營養支持第3天和第7天的熱卡分彆為(50.32 ±2.76) kcal/(kg·d)和(65.70±3.25) kcal/(kg·d),明顯高于死亡組(32.54±1.72) kcal/(kg·d)和(46.12±1.08) kcal/(kg·d) (P ＜0.05).存活組患兒Gln組免疫毬蛋白明顯高于非Gln組[IgG(4.93 ±2.1)g/L vs(4.01±1.03) g/L,IgA(0.31±0.07) g/L vs(0.19 ±0.03) g/L,IgM(0.52±0.08) g/L vs (0.32 ±0.10) g/L] (P ＜0.05),負氮平衡狀況也好于非Gln組[(-2.5±1.4)g/d vs(-5.3±1.3)g/d],差異有統計學意義(P＜0.05).結論 嚴重膿毒癥患兒疾病早期錶現為代謝率明顯升高,能量消耗明顯增加,蛋白分解利用大于閤成,呈現明顯負氮平衡,病情越重,機體代謝指標、營養指標、免疫毬蛋白等越低.對患兒進行PN時加用Gln很有必要.
목적 탐토엄중농독증환인영양지지치료방법.방법 198례엄중농독증환인진행생화지표、영양지표、혈기분석、혈상규이급입원후24 h뇨뇨소담등검측,근거환인궤체상황급여상응적영양지지,선택장내영양혹장외영양,혹동시급여장내영양화장외영양,장외영양조우분곡안선알(glutamine,Gln)조화비Gln조.감측엄중농독증존활환인급사망환인적영양지표급대사지표,포괄혈당、C반응단백、혈홍단백(Hb)、pH치、혈납、혈갑、곡병전안매、혈뇨소담、혈기항、혈유산,유산청제솔、혈감유삼지、혈총담고순、혈청전백단백(pre-albumin,PA)、시황순결합단백(retinal-binding protein,RBP)、혈청백단백(albumin,ALB)、24h뇨뇨소담.대존활급사망환인영양지지전0d급영양지지제3천、제7천적섭입열잡진행비교.대Gln조화비Gln조환인적면역구단백지표진행비교.결과 존활조환인영양지표균교사망조고[PA(130.0±30.0)mg/L vs (50.8±20.5)mg/L,RBP(22.3±10.3) mg/L vs (15.7±6.7) mg/L,ALB(35.3 ±8.1) g/L vs (28.7 ±6.2)g/L,Hb(113.2±27.7) g/L vs (95.3±10.6) g/L,IgA(0.40±0.03) g/Lvs (0.40±0.03)g/L,IgM(0.52±0.18) g/L vs (0.49±0.03) g/L] (P ＜0.05).존활조환인영양지지제3천화제7천적열잡분별위(50.32 ±2.76) kcal/(kg·d)화(65.70±3.25) kcal/(kg·d),명현고우사망조(32.54±1.72) kcal/(kg·d)화(46.12±1.08) kcal/(kg·d) (P ＜0.05).존활조환인Gln조면역구단백명현고우비Gln조[IgG(4.93 ±2.1)g/L vs(4.01±1.03) g/L,IgA(0.31±0.07) g/L vs(0.19 ±0.03) g/L,IgM(0.52±0.08) g/L vs (0.32 ±0.10) g/L] (P ＜0.05),부담평형상황야호우비Gln조[(-2.5±1.4)g/d vs(-5.3±1.3)g/d],차이유통계학의의(P＜0.05).결론 엄중농독증환인질병조기표현위대사솔명현승고,능량소모명현증가,단백분해이용대우합성,정현명현부담평형,병정월중,궤체대사지표、영양지표、면역구단백등월저.대환인진행PN시가용Gln흔유필요.
Objective To explore the methods of the nutritional support of children with severe sepsis.Methods The biochemical index,nutrition index,blood gas,blood routine and 24 hours urinary urea nitrogen of 198 children with severe sepsis were detected after hospitalization.Enteral nutrition,parenteral nutrition,or enteral and parenteral nutrition at the same time were selected for every children according to patients status.Children with parenteral nutrition were divided into glutamine (Gln) group and non-Gln group.Nutrition and metabolism indexes of survival and dead children were detected,including blood glucose,C-reactive protein,hemoglobin (Hb),pH,blood sodium,blood potassium,alanine transaminase,blood urea nitrogen,creatinine,blood lacticacid,lactate clearance rate,blood triglycerides,blood total cholesterol,serum pre-albumin (PA),retinal-binding protein (RBP),serum albumin (ALB) and 24 hours urinary urea nitrogen.The intake of calories were compared between survival and dead children before nutrition support (0 d),3 d and 7 d after nutrition support.Immunoglobulins of Gln group and non-Gln group were compared.Results The nutrition indexes of the survival group were higher than those of dead group [PA (130.0 ± 30.0) mg/L vs (50.8 ±20.5) mg/L,RBP(22.3 ±10.3) mg/L vs (15.7 ±6.7) mg/L,ALB(35.3 ±8.1) g/L vs (28.7 ±6.2) g/L,Hb(113.2 ±27.7) g/L vs (95.3 ±10.6) g/L,IgA(0.40 ±0.03) g/L vs (0.40 ±0.03) g/L,IgM(0.52 ±0.18) g/L vs (0.49 ±0.03) g/L] (P ＜0.05).The intake calories of survival group in 3 d and 7 d after nutrition support were (50.32 ±2.76) kcal/(kg·d) and (65.70 ±3.25) kcal/(kg·d),which were significantly higher than those of dead group [(32.54 ± 1.72) kcal/(kg·d) and (46.12 ± 1.08) kcal/(kg·d)).Among the survival children with parenteral nutrition,the levels of immunoglobulin in Gln group were higher than non-Gln group [IgG(4.93 ± 2.1) g/L vs (4.01 ± 1.03) g/L,IgA (0.31 ± 0.07) g/L vs (0.19 ±0.03) g/L,IgM(0.52 ±0.08) g/L vs (0.32 ±0.10) g/L] (P ＜0.05).Negative nitrogen balance was better in Gln group as(-2.5 ± 1.4) g/d than non-Gln group as (-5.3 ± 1.3) g/d(P ＜0.05).Conclusion Children with severe sepsis manifeste significantly increased metabolic rate and energy consumption,the protein decomposition utilization is greater than the synthetic with negative nitrogen balance.Children with more severe sepsis have lower metabolic indexes,nutrition indexes,and immunoglobulin.It is necessary for children with severe sepsis to use glutamine while having parenteral nutrition.
