重症急性胰腺炎患者静息能量消耗测定及意义  

Measurement and significance of resting energy expenditure in middle and old age patients with severe acute pancreatitis

作　　者：袁志高 周迈 邓五一 王达庆 焦岗军 陈宏[2] YUAN Zhigao;ZHOU Mai;DENG Wuyi;WANG Daqing;JIAO Gangjun;CHEN Hong(Department of General Surgery,Civil Aviation General Hospital,Beijing,100123,China;Department of General Surgery,Xuanwu Hospital,Capital Medical University)

机构地区：[1]民航总医院普外科,北京100123 [2]首都医科大学宣武医院普外科

出　　处：《临床急诊杂志》2020年第11期887-891,共5页Journal of Clinical Emergency

摘　　要：目的:采用间接能量测定(IC)法及Harris-Benedict(H-B)法检测并计算中老年重症急性胰腺炎(SAP)患者静息能量消耗(REE)值,并探讨REE与中老年SAP患者预后的关系。方法:选取2017-11—2019-12期间于我院就诊的122例急性胰腺炎(AP)患者为研究对象,其中轻症AP患者(MAP组)54例,重症AP患者(SAP组)68例;采用IC法、H-B法分别计算患者REE水平并比较,并对患者进行急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分及AP床旁严重度指数(BISAP)评分;比较不同APACHEⅡ评分、BISAP评分的SAP患者REE值水平;受试者工作特性曲线(ROC曲线)分析REE水平对SAP患者预后不良的预测价值。结果:SAP组APACHEⅡ评分、BISAP评分显著高于MAP组(P<0.05);SAP组REE值显著高于MAP组,HB法测定的REE值均显著高于IC法(P<0.05);APACHEⅡ评分>18.23组、BISAP评分>2.91组REE水平显著高于APACHEⅡ评分≤18.23组、BISAP评分≤2.91组(P<0.05);预后不良组REE水平显著高于预后良好组(P<0.05);REE水平预测SAP患者预后不良的曲线下面积(AUC)为0.897,截断值为1616.694kcal/d,特异度为69.2%,敏感度为96.6%。结论:SAP组REE值显著高于MAP组,患者REE水平的测定可能有助于为重症患者提供能量供给,从而改善中老年SAP患者的营养不良状态,对疾病的转归和患者的预后有重要意义。Objective:To measure and calculate the resting energy expenditure(REE)of middle and old age patients with severe acute pancreatitis(SAP)by indirect calorimetry(IC)and Harris Benedict(H-B)method,and to explore the relationship between REE and the prognosis of the middle and old age patients with SAP.Method:A total of 122acute pancreatitis(AP)patients in our hospital from November 2017to December 2019were selected as the research objects,including 54patients with mild AP(MAP group)and 68patients with SAP(SAP group).The levels of REE were calculated and compared by IC method and H-B method,and the patients were assessed by Acute Physiology And Chronic HealthⅡ(APACHEⅡ)and the bedside index for severity in acute pancreatitis(BISAP)scores;the REE values of SAP patients with different APACHEⅡscores and BISAP scores were compared;The receiver operating characteristic curve(ROC curve)was used to analyze the predictive value of REE level for poor prognosis of SAP patients.Result:The APACHEⅡscore and BISAP score in SAP group were significantly higher than those in MAP group(P<0.05).The REE value of SAP group was significantly higher than that of MAP group,and the REE value determined by HB method was significantly higher than that determined by IC group(P<0.05),The REE level of APACHEⅡscore>18.23group and BISAP score>2.91 group was significantly higher than that of APACHEⅡscore≤18.23group and BISAP score≤2.91group(P<0.05).The REE level of the poor prognosis group was significantly higher than that of the good prognosis group(P<0.05).The area under the curve(AUC)of the REE level predicting poor prognosis of SAP patients was 0.897,the cutoff value was 1616.694kcal/d,the specificity was 69.2%,and the sensitivity 96.6%.Conclusion:The REE value of SAP group is significantly higher than that of MAP group.The determination of REE level in group may be helpful to provide energy supply for severe patients,so as to improve the malnutrition status of middle and old age SAP patients,which is of great significance to the

关 键 词：重症急性胰腺炎 中老年 静息能量消耗 预后 

分 类 号：R657.51[医药卫生—外科学]