不同热卡供给对脓毒性休克100例预后的影响  

The effect of different calorie supply on the prognosis of 100 cases of septic shock

作　　者：王彩虹 王美霞[2] 姚哲放 王亚丽 李小洋 WANG Caihong;WANG Meixia;YAO Zhefang;WANG Yali;LI Xiaoyang(The First Clinical Medical College of Shanxi Medical University,Taiyuan,Shanxi 030001,China;Department of Critical Care Medicine,The First Hospital of Shanxi Medical University,Taiyuan,Shanxi 030001,China;Department of Critical Care Medicine,Shanxi Cardiovascular Disease Hospital,Taiyuan,Shanxi 030001,China)

机构地区：[1]山西医科大学第一临床医学院,山西太原030001 [2]山西医科大学第一医院重症医学科,山西太原030001 [3]山西省心血管病医院重症医学科,山西太原030001

出　　处：《安徽医药》2023年第7期1441-1446,共6页Anhui Medical and Pharmaceutical Journal

基　　金：黎介寿肠道屏障研究专项基金(LJS-201613)。

摘　　要：目的比较不同热卡供给对脓毒性休克病人预后的影响,以期为脓毒性休克病人提供最佳热卡供给。方法采用回顾性分析方法,选取山西医科大学第一临床医学院2019年8月至2021年8月符合纳入标准的100例脓毒性休克病人行营养支持治疗的临床资料,将病人按非蛋白热卡供给量分为A组、B组2组。A组喂养方式为渐进式喂养,入ICU第3天热卡达到目标热卡的70%,逐渐增加热卡到第7天达到目标热卡。B组喂养方式为等热卡喂养,入ICU第3天达到目标热卡,第3天到第7天目标热卡喂养。两组入院时一般资料相近,蛋白提供量相似。分别记录两组病人每日热卡供给量、蛋白供给量,第1天及第7天营养指标、肝肾功、血糖、胰岛素用量,记录住院期间机械通气时间、住院时间、住ICU时间、院内感染率、ICU病死率、28 d病死率等并进行比较。探讨热卡供给量与脓毒性休克病人预后的关系。结果两组给予7 d营养支持后,A组的胰岛素用量少于B组[20.00(0.00,50.00)IU比50.00(0.00,70.00)IU],A组的机械通气时间比B组短[(7.69±6.80)d比(12.44±14.02)d],A组的住院时间比B组短[(18.92±12.33)d比(28.02±22.07)d],A组的ICU住院时间比B组短[(14.92±10.91)d比(22.22±16.76)d],A组的28 d病死率低于B组[6例(12.2%)比22例(43.1%)],A组的院内感染率低于B组[3例(6.1%)比10例(19.6%)],差异有统计学意义(P<0.05)。结论脓毒性休克病人在提供充足蛋白质时,在急性期早期(1~3 d)给予低热卡喂养,急性期晚期(4~7 d)给予等热卡喂养,可以减少胰岛素需求,缩短机械通气时间、住院时间、住ICU时间,降低院内感染率、28 d病死率,改善预后。Objective To compare the effect of different caloric supply on the prognosis of patients with septic shock,in order to provide the best caloric supply for patients with septic shock.Methods A retrospective analysis was conducted to select the clinical data of 100 patients with septic shock who met the inclusion criteria from August 2019 to August 2021 and received nutritional support therapy in The First Clinical Medical College of Shanxi Medical University.The patients were divided into group A and group B according to the amount of non-protein calorie supply.Group A was fed gradually,70%of the target caloric calorie was reached on the third day in ICU,and the target caloric calorie was reached on the seventh day by gradually increasing calorie.The feeding method of group B was isocaloric diet,and the target calorie feeding was achieved on the 3rd day after admission to ICU,and the target calorie feeding was achieved from the 3rd day to the 7th day.The general information of the two groups at admission was similar and the amount of protein available was similar.Daily caloric calorie supply,protein supply,nutritional indexes,liver and kidney function,blood glucose and insulin dosage on day 1 and day 7,mechanical ventilation duration,hospitalization duration,ICU stay duration,nosocomial infection rate,ICU mortality rate and 28-day mortality rate were recorded and compared between the two groups.The relationship between caloric intake and prognosis of patients with septic shock was investigated.Results After 7 days of nutritional support,the insulin dosage in group A was less than that in group B[20.00(0.00,50.00)IU vs.50.00(0.00,70.00)IU],and the mechanical ventilation duration in group A was shorter than that in group B[(7.69±6.80)d vs.(12.44±14.02)d].The length of hospital stay in group A was shorter than that in group B(18.92±12.33 vs.28.02±22.07),and the length of ICU stay in group A was shorter than that in group B[(14.92±10.91)d vs.(22.22±16.76)d].The 28-day mortality in group A was lower than that in

关 键 词：休克 脓毒性 低热卡喂养 等热卡喂养 营养支持 病死率 

分 类 号：R459.7[医药卫生—急诊医学]