肠瘘病人的能量代谢特点  

Character of energy expenditure in gastrointestinal fistula patients

作　　者：王革非[1] 任建安[1] 姜军[1] 范朝刚[1] 王新波[1] 邹志英[1] 黎介寿[1] 

机构地区：[1]南京军区南京总医院解放军普通外科研究所,江苏南京210002

出　　处：《中国实验诊断学》2004年第3期213-216,共4页Chinese Journal of Laboratory Diagnosis

摘　　要：目的　分析肠瘘病人的能量代谢特点 ,为临床营养支持提供依据。材料与方法　从 2 0 0 1年 1月至 2 0 0 3年3月入院的 2 2 5例肠瘘病人入选本实验 ,根据病人的感染情况分为 3组 :无感染组、感染组和MODS组 ,检测病人疾病危重度的评分、CRP、尿总氮、能量代谢、细胞因子等指标。结果　无感染组病人 12 5例 ,感染组 82例 ,MODS组 18例。MODS组病人的死亡率达到 2 2 2 % ,显著高于无感染组 (1 6 % )和感染组 (2 0 % )。MODS组REE(1891 1± 16 1 1kcal)和感染组 (15 31 2± 15 5 0kcal)显著高于无感染组 (12 5 4 2± 10 2 3kcal) ,并且要显著高于通过Harris Benedict公式计算的REE预测值 ,比值分别为 1 5 2和 1 2 3,且MODS组REE显著高于感染组 (P <0 0 1)。APACHE II评分、SS评分、CRP、TNF α、IL 2、IL 4、IL 6、IL 8水平也表现出相同的趋势 ,即MODS组和感染组显著高于无感染组 ,MODS组显著高于感染组。多元线性回归分析显示REE的增高与CRP、TNF α、IL 6、IL 8水平升高显著相关。结论　合并腹腔感染和MODS的肠瘘病人 ,其REE显著增加 ,并且与CRP、TNF α、IL 6、IL 8水平显著相关。Objective To investigate and analysis the character of energy expenditure in gastrointestinal fistula patients.Methods Two hundred and twenty five gastrointestinal fistula patients during January 2001 to March 2003 were enrolled in this study. Based on the infection condition, these patients were divided into three groups:non-infection group, infection group, and MODS group. Acute Physiology and Chronic Health Evaluation(APACHE) Ⅱ scoring, sepsis score, C-reactive protein, urine nitrogen, energy expenditure, and cytokines were detected.Results There was 125 patients in non-infection group, 82 in infection group, and 18 in MODS group. Mortality of MODS group was significantly higher than non-infection group and infection group(1.6% and 2.0%, respectively). There was significant difference of Resting Energy Expenditure(REE) in MODS group, infection group and non-infection group(1891.1±161.1 kcal vs. 1531.2±155.0 kcal vs. 1254.2±102.3 kcal, P<0.01 respectively). REE in MODS group and infection group significantly increased than the Harris-Benedict formula predicted value, and the ratio was 1.52 and 1.23. There was significanu increase of APACHE-Ⅱ and sepsis score, serum concentration of CRP, TNF-α, IL-2, IL-4, IL-6, IL-8 and IL-10 in MODS group and infection group, and in MODS group there were even higher than in infection group. The increase of REE was significantly correlated with serum concentration of CRP, TNF-α, IL-6, and IL-8, based on linear regression analysis.Conclusion REE of the gastrointestinal fistula patients who suffered from infection or MODS increased significantly, and significantly correlated with serum concentration of CRP, TNF-α, IL-6, and IL-8, based on linear regression analysis.

关 键 词：肠瘘 能量代谢 细胞因子 APACHE-Ⅱ评分 营养支持 

分 类 号：R656.7[医药卫生—外科学]