重型颅脑损伤患者能量平衡及影响预后的因素分析  

Analysis of energy balance and risk factors on clinical outcomes in patients with severe traumatic brain injury

作　　者：肖桂珍[1] 王钦先[1] 邱小文[1] 段鹏凯[2] 黄英[1] 苏磊[1] 

机构地区：[1]510010广东,广州军区广州总医院营养科 [2]510010广东,广州军区广州总医院ICU

出　　处：《中国危重病急救医学》2012年第5期260-264,共5页Chinese Critical Care Medicine

基　　金：国家自然科学基金资助项目（81071529）

摘　　要：目的观察重型颅脑损伤患者的能量消耗，分析累积能量平衡与预后的关系。方法采用前瞻性自身前后对照的研究方法，使用间接能量测定仪监测42例重型颅脑损伤患者的能量改变，记录每日摄人热量，计算能量平衡，比较营养生化指标变化；用logistic回归分析累积能量平衡影响预后的情况。结果全部患者实际摄人能量平均为（67874±1848）kJ／d，能量负平衡平均为（9134±285）kJ／d。前3d能量负平衡最严重，实际摄入能量值明显低于目标能量值（kJ：28594±1370比60274-899，P〈O．01），随时间延长，实际摄入能量值逐渐上升，前14d是发生能量负平衡的主要时期。与入院3d比较，患者7d时血浆白蛋白（g／L）下降最为明显（29．5±5．0比35．94-3．8，P〈O．01），随后逐渐升高，至28d（34．14±2．8）已恢复至正常水平；入院3d前白蛋白（mg／L：122．54±23．3）明显低于正常水平，7d时（214．34±38．6）即明显升高（P〈O．01），并维持至28d（257．74-25．2）；入院3dC-反应蛋白（m虮：139．54±54．4）明显高于正常水平，7d时（108．44±42．2）即明显下降（P〈0．01），随后呈逐渐下降趋势。Logistic回归分析显示，累积能量负平衡与感染和上消化道出血等并发症相关[感染的优势比（OR值）2．130，95％可信区间（95％CI）为（1．540，29．661），P=O．023；上消化道出血的OR值0．083，95％CI（0．013，0．542），P=O．009]。结论累积能量负平衡与重型颅脑损伤患者的并发症相关；使用间接能量测定仪监测能量变化，及早补充足够的能量，可能改善患者的预后。Objective To observe the energy expenditure in severe traumatic brain injury patients, and to assess the impact of cumulative energy balance on clinical outcomes. Methods Using prospective self-controlled study, the change in energy expenditure of 42 patients with severe traumatic brain injury was measured by indirect calorimetry （ IC ）. Daily energy intake was recorded. Afterwards, energy balance was calculated. The levels of nutritional biochemical indicators were compared. Logistic regression analysis was used to analyze the correlation of cumulative energy balance with clinical outcomes. Results Mean practical energy intake of all patients was （6787±1848） k J/d, and mean negative energy balance was （913±285 ） kJ/d. The negative energy balance was most crucial in first 3 days after admission. Meanwhile, practical energy intake was significantly lower than target energy intake （k J： 2859±1370 vs. 6027±899, P〈0.01 ）. The practical energy intake was increased with time, and it was found that the first 14 days were crucial for development of negative energy balance. On 7th day after admission, albumin （g/L） level in plasma was lowest compared with that on 3rd day （29.5±5.0 vs. 35.9±3.8, P〈0.01 ）, and then it was increased gradually returning to normal level on 28 days （34.1±2.8 ）. Three days after admission, prealbumin （mg/L： 122.5±23.3 ） was obviously lower than normal level, but it rapidly elevated on 7th day （214.3 ＋ 38.6, P〈0.01 ） and continued to rise till 28th day （257.7± 25.2）. On the Od day after admission, C-reactive protein （mg/L： 139.5±54.4） was obviously higher than norulal level. However, it significantly fell on 7th day （ 108.4±42.2, P〈0.01 ）, and it continued to fall. Logistic regression analysis showed a strong association of cumulative negative energy balance with infection and upper gastrointestinal bleeding ~ odds ratio （OR） of infection was 2.130, 95% confidence interval （ 95% CI） 1.540 to 29.661, P =0.023; OR of

关 键 词：颅脑损伤 能量平衡 并发症 间接测热法 

分 类 号：R651.1[医药卫生—外科学]