先天性心脏病患儿术后静息能量消耗  

Postoperative resting energy expenditure in children with congenital heart disease

作　　者：谢丽清[1] 洪莉[1] 冯一[1] 常盼盼[1] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心临床营养科,200127

出　　处：《中华临床营养杂志》2017年第2期78-83,共6页Chinese Journal of Clinical Nutrition

摘　　要：目的 应用间接测热法（IC）测定先天性心脏病术后机械通气患儿的静息能量消耗（REE）,探究先天性心脏病患儿术后静息能量代谢规律及可能影响因素.方法 纳入2015年2至6月入住上海儿童医学中心心胸外科重症监护室的先天性心脏病术后患儿共150例,于术后4 h应用代谢车测定REE.收集患儿一般人口学和人体测量学资料、 临床资料,分析临床因素与REE的相关性.比较患儿术后营养摄入与REE的关系.结果 入组患儿150例,男104例、 女46例,中位年龄14（8.3-36.0）个月.IC测得非蛋白呼吸商为0.79±0.20,REE实测值（MREE）（264.76±61.74）kJ/（kg·d）,与Schofield公式估算值（278.51±93.42）kJ/（kg·d）比较,差异无统计学意义（P=0.096）,但相关性较低（R^2=0.119）;多因素逐步回归分析显示先天性心脏病风险校正评分（RACHS-1）与MREE呈显著正相关（P=0.012）、 年龄与MREE呈显著负相关（P=0.010）.术后97.33%（146/150）患儿第1天摄入热量低于MREE.结论 先天性心脏病术后并未出现明显高代谢状态,但影响底物代谢.RACHS-1评分、 年龄是影响患儿术后REE的因素.先天性心脏病患儿术后第1天摄入热量普遍低于REE.Objective To determine postoperative resting energy expenditure （ REE） in children with congenital heart disease （ CHD） requiring open heart surgery , to compare measured resting energy expenditure （MREE） with current predictive equations （PEE）, and to investigate the possible influencing factors on the metabolic status of the postoperative CHD children .Methods From February 2015 to June 2015 , 150 ventilated children admitted to the cardiac intensive care unit after surgery for congenital heart disease in Shanghai Children＇s Medical Center were enrolled consecutively .Indirect calorimetry （ IC） measurements were performed using metabolic cart 4 hours after surgery .General clinical data were recorded .Results Totally 104 male and 46 female patients were enrolled, with a median age of 14 months （8.3-36.0 months）.The non-protein respiratory quotient of patient was 0.79 ±0.20, MREE was （264.76 ±61.74） kJ/（kg· d）, and PEE using Schofield equations was （278.51 ±93.42） kJ/（kg· d）.Although there was no significant differences （P=0.096 ） between MREE and PEE , the agreement was poor between them （ R^2 =0.119 ） .Multivariate stepwise regression analysis showed that MREE had significant positive correlation with risk adjustment in congenital heart surgery （RACHS-1） score （P=0.012） and negative correlation with age （P=0.010）.Up to 97.33%of children （146/150） had lower energy intake compared with MREE on the 1st postoperative day .Conclusions MREE does not increase after surgery in CHD children;however , the substrate utilization is influenced . Factors influencing the postoperative REE include RACHS-1 score and age.The energy intake at 1st day after surgery is generally lower than REE in these children .

关 键 词：儿童 先天性心脏病 静息能量消耗 间接能量测热法 

分 类 号：R726.5[医药卫生—儿科]