间接能量测定法指导个体化营养方案对休克型肺炎患者能量代谢的影响  

Effect of individualized nutrition program guided by indirect energy measurement on energy metabolism in patients with shock pneumonia

作　　者：刘璐 王小娟 苗磊 颜瑶[1] Liu Lu;Wang Xiao-juan;Miao Lei;Yan Yao(Department of Intensive Care Medicine,The Second People's Hospital of Lianyungang(Lianyungang Clinical College,Bengbu Medical University),Lianyungang 222006,China)

机构地区：[1]连云港市第二人民医院(蚌埠医科大学连云港临床学院)重症医学科,连云港222006

出　　处：《中国药物应用与监测》2024年第3期239-243,共5页Chinese Journal of Drug Application and Monitoring

基　　金：连云港市卫生计生科技项目(QN1808);蚌埠医学院科技项目自然科学类(2022byzd176)。

摘　　要：目的探讨间接能量测定法指导个体化营养方案对休克型肺炎患者能量代谢的影响。方法选择2020年1月至2023年1月在连云港市第二人民医院接受治疗的96例休克型肺炎患者,分别采用间接能量测定法(能量代谢监护仪)计算每日静息能量消耗(REE)值,根据随机数字表法分为观察组(48例)与对照组(48例),观察组制定个体化营养方案,对照组采用匀浆膳方案。比较两组患者营养支持治疗前后蛋白质代谢营养指标、上臂肌围、体质量指数、血糖及预后情况。结果观察组治疗2周后总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)水平、上臂肌围、体质量指数[分别为(66.42±12.37)g·L^(-1),(38.44±3.25)g·L^(-1),(28.37±2.89)g·L^(-1),(25.96±2.03)cm,(22.93±1.62)kg·m^(-2)]均高于对照组[分别为(58.57±11.48)g·L^(-1),(34.37±3.89)g·L^(-1),(24.88±3.16)g·L^(-1),(23.87±1.89)cm,(21.64±1.58)kg·m^(-2)](t=3.223,5.563,5.646,5.221,3.950,均P<0.05),而空腹血糖(FPG),餐后2 h血糖(2 h PG)水平[分别为(6.36±1.02)mmol·L^(-1),(8.05±1.64)mmol·L^(-1)]均低于对照组[分别为(7.54±1.09)mmol·L^(-1),(9.87±1.52)mmol·L^(-1)](t=5.476,5.639,均P<0.05)。观察组机械通气时间,ICU住院时间,28 d病死率及发热发生率[分别为(9.09±1.48)d,(15.36±1.78)d,18.75%,8.33%]均低于对照组[分别为(10.37±1.56)d,(17.49±1.67)d,27.08%,22.92%](t=4.124,6.046,χ^(2)=0.944,3.872,均P<0.05)。结论间接能量测定法指导个体化营养方案能有效改善休克型肺炎患者营养状况及预后。Objective To investigate the effect of indirect energy measurement on energy metabolism in patients with shock pneumonia under the guidance of individualized nutrition program.Methods Ninety-six patients with shock pneumonia treated in The Second People's Hospital of Lianyungang from January 2020 to January 2023 were selected as the subjects.The daily resting energy expenditure(REE)values were calculated using indirect calorimetry(energy metabolism monitor).According to the random number table method,these patients were divided into the observation group(n=48)and control group(n=48).The observation group was formulated with an individualized nutritional regimen,while the control group was provided with a homogenized diet regimen.The protein metabolism nutritional indicators,upper arm muscle circumference,body mass index,blood glucose levels and prognostic outcomes were compared between the two groups before and after nutritional support treatment.Results After 2 weeks of treatment,the observation group showed higher levels of total protein(TP),albumin(ALB),prealbumin(PA),upper arm muscle circumference and body mass index(66.42±12.37)g·L^(-1),(38.44±3.25)g·L^(-1),(28.37±2.89)g·L^(-1),(25.96±2.03)cm and(22.93±1.62)kg·m^(-2) than those of the control group((58.57±11.48)g·L^(-1),(34.37±3.89)g·L^(-1),(24.88±3.16)g·L^(-1),(23.87±1.89)cm and(21.64±1.58)kg·m^(-2))(t=3.223,5.563,5.646,5.221,3.950,all P<0.05).Meanwhile,the fasting plasma glucose(FPG)and 2-h postprandial blood glucose(2hPG)levels were(6.36±1.02)mmol·L^(-1),(8.05±1.64)mmol·L^(-1),respectivley,in the observation group,which were lower than those of the control group((7.54±1.09)mmol·L^(-1),(9.87±1.52)mmol·L^(-1))(t=5.476,5.639,both P<0.05).The observation group also had shorter duration of mechanical ventilation((9.09±1.48)d vs(10.37±1.56)d),fewer ICU hospitalization time((15.36±1.78)d vs(17.49±1.67)d),a lower 28-day mortality rate(18.75%vs 27.08%)and a lower incidence of fever(8.33%vs 22.92%)as compared with the control group(t=4

关 键 词：休克型肺炎 间接能量测定法 个体化营养方案 能量代谢 营养状况 

分 类 号：R459.3[医药卫生—治疗学] R563.1[医药卫生—临床医学]