中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2012年
11期
847-850
,共4页
董鸿捌%杨燕文%王莹%洪莉
董鴻捌%楊燕文%王瑩%洪莉
동홍팔%양연문%왕형%홍리
机械通气%危重病%儿童%能量代谢%静息能量消耗
機械通氣%危重病%兒童%能量代謝%靜息能量消耗
궤계통기%위중병%인동%능량대사%정식능량소모
Mechanical ventilation%Critically ill%Children%Energy metabolism%Resting energy expenditure
目的 了解机械通气危重病儿童能量代谢状态,评价常用能量消耗预测公式在机械通气危重病儿童中的适用性,探讨机械通气危重病儿童能量代谢与疾病危重评分之间的关系.方法 以50例PICU机械通气的危重病儿童为研究对象,机械通气治疗20 ～ 26 h时,采用The MedGrapics CCM/D System能量代谢测定系统测定静息能量消耗值(MREE);运用Schofield-HTWT公式和White公式计算入选患儿的预测静息能量消耗值(PREE);按《国内小儿危重病例评分法》(PCIS)和《PICU死亡风险评分》(PRISM3)进行疾病严重程度评估.该研究经本院医学伦理委员会批准并获研究对象的家长知情同意后纳入研究.结果 机械通气20 ～ 26 h时,所有患儿的平均PRISM3评分和PCIS评分分别为(7±3)和(82±4)分,MREE和Schofield-HTWT公式预测值、White公式预测值分别为(404.80±178.28)、(462.82±160.38)和(427.97±152.30) kcal/d(1 kcal =4.184KJ).其中35例(70％)患儿的MREE小于90％ Schofield-HTWT预测值,5例(10％)患儿的MREE大于110％Schofield-HTWT预测值.MREE与两种预测公式值差异有统计学意义(F =3.648,P=0.029).MREE与PRISM3评分(P =0.354)和国内危重病评分(P=0.068)差异无统计学意义.结论 机械通气危重病儿童大多数呈现低代谢状态;国外常用的Schofield-HTWT公式和White公式均不能准确预测机械通气儿童的静息能量消耗,两个预测公式均过高估计了患儿的实际能量消耗.机械通气危重病儿童的静息能量消耗与疾病的危重评分无相关性.
目的 瞭解機械通氣危重病兒童能量代謝狀態,評價常用能量消耗預測公式在機械通氣危重病兒童中的適用性,探討機械通氣危重病兒童能量代謝與疾病危重評分之間的關繫.方法 以50例PICU機械通氣的危重病兒童為研究對象,機械通氣治療20 ～ 26 h時,採用The MedGrapics CCM/D System能量代謝測定繫統測定靜息能量消耗值(MREE);運用Schofield-HTWT公式和White公式計算入選患兒的預測靜息能量消耗值(PREE);按《國內小兒危重病例評分法》(PCIS)和《PICU死亡風險評分》(PRISM3)進行疾病嚴重程度評估.該研究經本院醫學倫理委員會批準併穫研究對象的傢長知情同意後納入研究.結果 機械通氣20 ～ 26 h時,所有患兒的平均PRISM3評分和PCIS評分分彆為(7±3)和(82±4)分,MREE和Schofield-HTWT公式預測值、White公式預測值分彆為(404.80±178.28)、(462.82±160.38)和(427.97±152.30) kcal/d(1 kcal =4.184KJ).其中35例(70％)患兒的MREE小于90％ Schofield-HTWT預測值,5例(10％)患兒的MREE大于110％Schofield-HTWT預測值.MREE與兩種預測公式值差異有統計學意義(F =3.648,P=0.029).MREE與PRISM3評分(P =0.354)和國內危重病評分(P=0.068)差異無統計學意義.結論 機械通氣危重病兒童大多數呈現低代謝狀態;國外常用的Schofield-HTWT公式和White公式均不能準確預測機械通氣兒童的靜息能量消耗,兩箇預測公式均過高估計瞭患兒的實際能量消耗.機械通氣危重病兒童的靜息能量消耗與疾病的危重評分無相關性.
목적 료해궤계통기위중병인동능량대사상태,평개상용능량소모예측공식재궤계통기위중병인동중적괄용성,탐토궤계통기위중병인동능량대사여질병위중평분지간적관계.방법 이50례PICU궤계통기적위중병인동위연구대상,궤계통기치료20 ～ 26 h시,채용The MedGrapics CCM/D System능량대사측정계통측정정식능량소모치(MREE);운용Schofield-HTWT공식화White공식계산입선환인적예측정식능량소모치(PREE);안《국내소인위중병례평분법》(PCIS)화《PICU사망풍험평분》(PRISM3)진행질병엄중정도평고.해연구경본원의학윤리위원회비준병획연구대상적가장지정동의후납입연구.결과 궤계통기20 ～ 26 h시,소유환인적평균PRISM3평분화PCIS평분분별위(7±3)화(82±4)분,MREE화Schofield-HTWT공식예측치、White공식예측치분별위(404.80±178.28)、(462.82±160.38)화(427.97±152.30) kcal/d(1 kcal =4.184KJ).기중35례(70％)환인적MREE소우90％ Schofield-HTWT예측치,5례(10％)환인적MREE대우110％Schofield-HTWT예측치.MREE여량충예측공식치차이유통계학의의(F =3.648,P=0.029).MREE여PRISM3평분(P =0.354)화국내위중병평분(P=0.068)차이무통계학의의.결론 궤계통기위중병인동대다수정현저대사상태;국외상용적Schofield-HTWT공식화White공식균불능준학예측궤계통기인동적정식능량소모,량개예측공식균과고고계료환인적실제능량소모.궤계통기위중병인동적정식능량소모여질병적위중평분무상관성.
Objective Energy metabolism of critically ill children has its own characteristics,especially for those undergoing mechanical ventilation.We tried to assess the energy expenditure status and evaluate the use of predictive equations in such children.Moreover,the characteristics of the energy metabolism among various situation were explored.Method Fifty critically ill children undergoing mechanical ventilation were selected in this study.Data produced during the 24 hours of mechanical ventilation were collected for computation of severity of illness.Resting energy expenditure (REE) was determined at 24 hours after mechanical ventilation (MREE).Predictive resting energy expenditure(PREE) was calculated for each subject using age-appropriate equations (Schofield-HTWT,White).The study was approved by the hospital medical ethics committee and obtained parental written informed consent.Result The pediatric risk of mortality score 3 (PRISM3) and pediatric critical illness score (PCIS) were (7 ± 3) and (82 ± 4),respectively.MREE,Schofield-HTWT equation PREE and White equation PREE were (404.80 ± 178.28),(462.82 ± 160.38) and (427.97 ± 152.30) kcal/d,respectively; 70％ were hypometabolic and 10％ were hypermetabolic.MREE and PREE which were calculated using Schofield-HTWT equation and White equation,both were higher than MREE (P =0.029).Correlation analysis was performed between PRISM3 and PCIS with MREE.There were no statistically significant correlation (P ＞0.05).Conclusion The hypometabolic response is apparent in critically ill children with mechanical ventilation;Schofield-HTWT equation and White equation could not predict energy requirements within acceptable clinical accuracy.In critically ill children undergoing mechanical ventilation,the energy expenditure is not correlated with the severity of illness.
