| 代谢车指导热射病患者的营养支持治疗 |
| 投稿时间：2017-10-20 修订日期：2017-10-30 点此下载全文 |
| 引用本文：吴长江,茅怡铭,隋明亮,刘会平,李星.代谢车指导热射病患者的营养支持治疗[J].医学研究杂志,2018,47(7):145-148,154 |
| DOI：
10.11969/j.issn.1673-548X.2018.07.034 |
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| 中文摘要:目的 观察代谢车指导热射病患者营养支持的疗效。方法 回顾性分析2012年7月~2017年7月期间上海交通大学医学院附属苏州九龙医院重症医学科、苏州科技城医院重症医学科收治的热射病患者，共计63例，按照排除标准排除6例后最终共计纳入57例，其中实验组29例，对照组28例。两组患者均给予常规相同治疗，实验组采用代谢车测定每日日需能量用于指导每日营养支持治疗，对照组采用传统Harris-Benedict公式测定每日日需能量用于指导每日营养支持治疗，疗程均为5天。观察两组患者每日日需能量（kcal/d），呼吸机使用时间（d），住ICU时间（d），住院时间（d），治疗第5天APACHEⅡ评分（分），治疗第1天及治疗第5天的上臂肌围（cm）、总蛋白（g/L）、白蛋白（g/L）、前白蛋白（mg/L）、淋巴细胞计数（109/L）、血红蛋白（g/L）以及病死率等指标。结果 实验组每日日需能量（kcal/d）、治疗第5天的白蛋白（g/L）、前白蛋白（mg/L）等指标均大于对照组，其差异有统计学意义（P<0.05）。实验组患者在住ICU时间（d）及住院时间（d）方面小于对照组患者，其差异有统计学意义（P<0.05）。两组患者在呼吸机使用时间（d），治疗第5天APACHEⅡ评分（分）、治疗第1天的上臂肌围（cm）、总蛋白（g/L）、白蛋白（g/L）、前白蛋白（mg/L）、淋巴细胞计数（109/L）、血红蛋白（g/L），治疗第5天的上臂肌围（cm）、总蛋白（g/L）、淋巴细胞计数（109/L）、血红蛋白（g/L）以及病死率等指标方面比较，差异无统计学意义。从同一组患者不同时间点的营养指标方面之间比较来看，实验组患者治疗第5天的上臂肌围（cm）、总蛋白（g/L）、白蛋白（g/L）、前白蛋白（mg/L）、淋巴细胞计数（109/L），血红蛋白（g/L）等各项指标均大于治疗其在第1天时的各项指标，其差异有统计学意义（P<0.05）。对照组患者仅治疗第5天的淋巴细胞计数（109/L）高于其在治疗第1天的淋巴细胞计数（109/L），治疗第5天的其余营养指标与其在治疗第1天时的各项营养指标比较，差异无统计学意义。结论 热射病患者运用代谢车能更精准地评估营养状态，指导营养支持治疗，值得临床广泛推广及应用。 |
| 中文关键词:代谢车 热射病 多器官功能障碍综合征 营养支持 |
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| Clinical Study of Metabolic Cart Guiding Nutritional Support Therapy in Patients with Heat Stroke |
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| Abstract:Objective To investigate the effect of metabolic cart in the treatment of guiding nutritional support therapy in patients with heat stroke. Methods A retrospective analysis was performed on the medical records of 63 cases with heat stroke disease,according to the exclusion standard out of 6 cases,and 57 cases of patients with heat stroke were analyzed from July 2012 to July 2017 in the department of Intensive Care Unit of our hospital.Twenty-nine cases were in the experiment group and 28 cases in the control group. All the patients in two groups were given the same basic treatment. The experimental group usedmetabolic cart to guide daily nutrition support treatment for patientsfor 5 days while the control group used Harris-Benedict formula to guide daily nutrition support treatmentfor 5 days. Parameters were observed including daily energy requirement(kcal/d),mechanical ventilation time(d),ICU stay time(d),hospital stay time(d), APACHEⅡ score of the fifth day after treatment,upper arm circumference of the first and fifth day after treatment(cm),total protein(g/L),albumin(g/L),prealbumin(mg/L),lymphocyte count(109/L),hemoglobin(g/L), mortality rate in two group patients. Results In our study T test and Mann-whitney U test showed that Daily energy requirement, albumin andprealbumin of the fifth day after treatment varied significantlyin the experimental groupwas more than that in the control group.According to this research it indicated that ICU stay time and hospital stay time in the experimental group were less than that in the control group. There were no significant differences between the two group in themechanical ventilation time, APACHEⅡ of the fifth day after treatment,upper arm circumference of the first day after treatment,and total protein,albumin,prealbumin,lymphocyte count,hemoglobin,upper arm circumference of the fifth day after treatment,total protein, lymphocyte count,hemoglobin, and mortality rate. There was significantly difference between Upper arm circumference of the fifth day,total protein, albumin,prealbumin, lymphocyte count,hemoglobinin the same experimental groupwere more than that in the experimental group of the first day after treatment, while only lymphocyte count of the fifth day after treatment in the control group was more than that in the control group of the first day after treatment. Conclusion Metabolic cart in the treatment of guiding nutritional support therapy in patients has good curative effect. |
| keywords:Metabolic cart Heat stroke MODS Nutritional support |
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