代谢车在成人急性自发性脑出血危重症患者营养支持中的价值  

作　　者：江玲芝[1] 孙仁华[1] 徐云祥[1] 陈娟红[1] 

机构地区：[1]浙江省人民医院ICU,310014

出　　处：《浙江临床医学》2016年第11期2006-2008,共3页Zhejiang Clinical Medical Journal

摘　　要：目的：探讨代谢车在成人自发性脑出血危重症患者目标能量指导中的意义，为合理的营养支持治疗提供更为精确的目标。方法成人急性自发性脑出血需有创机械通气的患者36例，随机分为观察组与对照组各18例。观察组按代谢车测定的静息能量消耗值指导营养治疗，对照组按Harris-Benedict公式乘以应激系数（1.2）的计算值指导营养治疗。比较两组患者在不同目标能量指导下进行营养支持治疗前及治疗7d后营养相关指标、免疫功能指标、ICU内停留时间、机械通气时间、抗生素使用时间及28d病死率的差异。结果治疗7d后观察组转铁蛋白水平、HLA-DR表达水平均高于对照组（P〈0.05），而两组间血白蛋白、总蛋白、前白蛋白、IG、总CD3＋、CD4＋、CD8＋、CD4＋CD25＋差异无统计学意义（P＆gt;0.05）。两组之间ICU内停留时间、机械通气时间及28d病死率、抗生素使用时间均差异无统计学意义（P＆gt;0.05）。结论营养支持治疗对营养指标能有所改善。应用代谢车指导营养治疗转铁蛋白水平、HLA-DR表达水平较公式计算指导营养治疗者明显上升。代谢车指导下的营养支持方案能更好地改善机体营养状态。Objective The purpose of this study is to investigate the use of indirect calomeritry（IC）in nutritional support in critical patients with acute spontaneous intracerebraI hemorrhage（ICH）. Methods Admitted from November 2014 to February 2015,36 acute spontaneous ICH adults who required invasive mechanical ventilation were divided randomly into research and control group,18 in each. For the research group,the IC was used for measuring resting energy expenditure（REE）to develop nutritional regimens while for the control group,Harris-Benedict predictive equation multiplied by 1.2 was used as the destination. The differences of albumin,total protein,prealbumin,transferrin,IG,total CD3＋, CD4＋,CD8＋,CD4＋CD25＋,HLA-DR,days of ventilation,ICU length of stay,days of antibiotics and 28-day mortality between the two groups before nutritional support and seven days after that were tested. Results After seven days of nutritional support,transferrin and HLA-DR of the research group were significantly higher than those of the control group（P〈0.05）,while there were no significant differences of albumin,total protein,prealbumin,IG,total CD3＋,CD4＋,CD8＋and CD4＋CD25＋between the two groups（P＆gt;0.05）. No distinctions were found in the days of ventilation,ICU length of stay,28-day mortality and the days of antibiotics（P＆gt;0.05）. Conclusion Transferrin and HLA-DR are significantly higher in the research group than those of the control group. Nutritional support improves nutritional status,nutritional support under the guidance of IC improves nutritional status better.

关 键 词：代谢车 成人急性自发性脑出血 危重症 营养支持 

分 类 号：R743.34[医药卫生—神经病学与精神病学]