机械通气危重病儿童静息能量消耗测定的前瞻性研究  

Determination of resting energy expenditure in critically ill children experiencing mechanicalventilation

作　　者：董鸿捌[1] 杨燕文[1] 王莹[1] 洪莉[1] 

机构地区：[1]上海交通大学医学院附属儿童医学中心重症监护病房,200127

出　　处：《中华儿科杂志》2012年第11期847-850,共4页Chinese Journal of Pediatrics

基　　金：世界健康基金会上海儿童医学中心雅培/世界健康基金会临床营养发展中心

摘　　要：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20～26h时，采用The MedGrapics CCM／DSystem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20～26h时，所有患儿的平均PRISM3评分和PCIS评分分别为（74-3）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（1kcal=4．184KI）。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％Sehofield－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Sehofield-}rrwT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。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 energyexpenditure is not correlated with the severity of illness.

关 键 词：机械通气 危重病 儿童 能量代谢 静息能量消耗 

分 类 号：R720.597[医药卫生—急诊医学]