特重度烧伤患者代谢高涨期进行基于间接测热法的营养治疗的效果  

Effects of nutritional therapy based on indirect calorimetry in patients with extremely severe burns during hypermetabolic stage

作　　者：姜彬 都勇 夏一兰[1] 陈华清 卢福长 Jiang Bin;Du Yong;Xia Yilan;Chen Huaqing;Lu Fuchang(Nursing Department,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属第二医院护理部,杭州310000

出　　处：《中华烧伤与创面修复杂志》2025年第1期94-100,共7页Chinese Journal of Burns And Wounds

基　　金：浙江省医药卫生科技计划项目(2024KY087,2024KY1075)。

摘　　要：目的探讨特重度烧伤患者代谢高涨期进行基于间接测热法的营养治疗的效果。方法该研究为回顾性队列研究。2022年3月25日—2024年3月30日,浙江大学医学院附属第二医院烧伤与创面修复科收治了20例符合入选标准的特重度烧伤患者,其中男15例、女5例,年龄为(46±12)岁。根据患者治疗结局,将患者分为死亡组(6例)和存活组(14例)。伤后第3、7、14、21天,应用间接测热法测定2组患者静息能量消耗(REE),每天1次,并根据REE结果制订营养治疗方案。收集2组患者伤后第3、7、14、21天的REE值及白蛋白、白细胞介素6(IL-6)水平以及实际摄入能量、肠内营养摄入能量(最后2个指标分别以伤后第3~6、7~10、14~17、21~24天的均值表示),并计算实际摄入能量/REE值、肠内营养摄入能量/实际摄入能量。结果存活组和死亡组患者伤后第3、7、14、21天的REE值分别为(8143±2328)、(9843±2610)、(10149±2248)、(9608±2838)kJ和(6816±2057)、(10691±2515)、(11031±2850)、(8990±2018)kJ。2组患者伤后第3~21天REE值、肠内营养摄入能量均呈先上升后下降的趋势,但2组患者各时间点2个指标组间两两比较,差异均无统计学意义(P>0.05)。存活组患者伤后第21天实际摄入能量显著高于伤后第3天(P<0.05),死亡组患者伤后第14天肠内营养摄入能量明显高于伤后第3天(P<0.05)。2组患者伤后各时间点实际摄入能量/REE值、肠内营养摄入能量/实际摄入能量组间和组内总体比较,差异均无统计学意义(P>0.05)。存活组患者伤后第21天IL-6水平明显低于伤后第3、7天(P值均<0.05),明显高于伤后第14天(P<0.05);死亡组患者伤后第21天IL-6水平明显高于伤后第3、7、14天(P值均<0.05)。存活组患者伤后第7天白蛋白水平明显高于伤后第3天(P<0.05)。结论特重度烧伤患者代谢高涨期REE值和肠内营养摄入能量均呈先上升后下降的趋势,但对患者临床结局无显著影响。基�Objective To explore the effects of nutritional therapy based on indirect calorimetry in patients with extremely severe burns during hypermetabolic stage.MethodsThis study was a retrospective cohort study.From March 25,2022 to March 30,2024,20 extremely severe burn patients who met the inclusion criteria were admitted to the Department of Burn and Wound Repair of the Second Affiliated Hospital of Zhejiang University School of Medicine.There were 15 males and 5 females,aged(46±12)years.The patients were divided into death group(6 cases)and survival group(14 cases)according to their treatment outcomes.At the 3 rd,7 th,14 th,and 21 st d after injury,the resting energy expenditure(REE)of patients in the two groups was measured by indirect calorimetry once a day,and the nutritional treatment scheme was formulated according to the results of REE.The REE value,levels of albumin and interleukin-6(IL-6),actual energy intake,and enteral nutrition energy intake of patients in the two groups at the 3 rd,7 th,14 th,and 21 st d after injury were collected(the last two indicators were respectively expressed as the mean values of the 3 rd to 6 th,7 th to 10 th,14 th to 17 th,and 21 st to 24 th d after injury).The actual energy intake/REE value and enteral nutrition energy intake/actual energy intake were calculated.ResultsThe REE values of patients in survival group and death group were(8143±2328),(9843±2610),(10149±2248),(9608±2838)kJ and(6816±2057),(10691±2515),(11031±2850),(8990±2018)kJ,respectively at the 3 rd,7 th,14 th,and 21 st d after injury.The REE value and enteral nutrition energy intake of patients in the two groups showed trends of increase first and decrease then from the 3 rd to 21 st d after injury,while the differences in the above two indicators at each time point between the two groups of patients were not statistically significant(P>0.05).The actual energy intake of patients in survival group at the 21 st d after injury was significantly higher than that at the 3 rd d after injury(P<0.05),and the ent

关 键 词：烧伤 量热法 间接 能量代谢 营养支持 预后 

分 类 号：R47[医药卫生—护理学]