摘要
目的总结烧伤患者的能量代谢特点,观察烧伤严重程度、炎症指标、营养代谢指标和烧伤并发症等因素对患者静息能量消耗(REE)及呼吸商(RQ)的影响。方法采用回顾性调查研究方法,选择河北医科大学第一医院2016年4月至2018年3月收治的采用间接能量测定仪(代谢车)测定REE不同程度烧伤患者26例。观察患者的烧伤程度以及全身炎症反应综合征(SIRS)、吸入性肺损伤、应激性高血糖、休克等并发症发生情况;收集患者白细胞计数(WBC)、中性粒细胞/淋巴细胞比值(NLR)、C-反应蛋白(CRP)、血红蛋白(Hb)、总蛋白、白蛋白等资料;比较不同烧伤程度和有无SIRS、应激性高血糖、烧伤性休克等并发症患者REE、RQ的差异;分析烧伤患者炎症指标、营养代谢指标、总体表面积(TBSA)、Ⅲ度TBSA、烧伤后天数(PBD)、体表面积(BSA)与REE和RQ的相关性。结果26例患者中,轻度烧伤7例,中度烧伤10例,重度烧伤5例,特重度烧伤4例;烧伤总面积为11.50(25.00)%TBSA,Ⅲ度体表烧伤面积为5.00(12.00)%TBSA。不同烧伤程度患者REE和RQ比较差异均无统计学意义(均P>0.05)。相关性分析显示:CRP、Ⅲ度TBSA、BSA与实测REE呈明显正相关rs值分别为0.402、0.410、0.508,P值分别为0.042、0.038、0.008),Hb与实测REE呈明显负相关(rs=-0.606,P=0.001),Ⅲ度TBSA与RQ呈明显负相关(rs=-0.466,P=0.016);BSA与预计REE呈明显正相关(rs=0.863,P=0.000)。根据诊断标准和疾病生理状态显示发生SIRS 8例,应激性高血糖7例,吸入性肺损伤12例,休克9例,有SIRS患者RQ明显高于无SIRS者〔0.86(0.14)比0.81(0.14),P<0.05〕,说明SIRS的发生影响了RQ。而其他并发症对能量代谢和RQ无影响。结论CRP、Ⅲ度TBSA、BSA可影响烧伤患者REE,SIRS和Ⅲ度TBSA影响烧伤患者RQ,以上结论对烧伤患者营养支持方案的选择有一定指导意义。
Objective To summarize the characteristics of energy metabolism in burn patients and observe the effects of following factors,such as burn severity degree,inflammation index,nutritional metabolism index and burn complications on resting energy expenditure(REE)and respiratory quotient(RQ).Methods A retrospective survey was conducted for 26 burn patients admitted from April 2016 to March 2018 into the First Hospital of Hebei Medical University,and the patients'different degrees of REE were measured by a indirect calorimetry(metabolic vehicle).The burn degrees of the patients and the occurrence of complications such as systemic inflammatory response syndrome(SIRS),inhalation injury,stress hyperglycemia and shock were observed;the white blood cell count(WBC),neutrophil/lymphocyte ratio(NLR),C-reactive protein(CRP),hemoglobin(Hb),total protein,albumin and other data were collected.The differences in REE and RQ among patients with various burn degrees,and those with or without complications,such as SIRS,stress hyperglycemia,burn shock,etc.were compared;the correlations of following various burn patients'factors:indexes of inflammation and nutritional metabolism,the total burn body surface areas(TBSA),the ratios of third(Ⅲ)degree injury areas of TBSA,post-burn days(PBD)and body surface areas(BSA),with REE and RQ were analyzed.Results A total of 26 burn patients including 7 cases with mild,10 moderate,5 severe and 4 specially severe burns were enrolled in this study;the total body surface burn area was 11.50(25.00)%TBSA,and the total surface area of burnⅢdegree was 5.00(12.00)%TBSA.There were no significant differences in comparisons of REE,RQ among patients with different burn degrees(all P>0.05).Correlation analyses showed that CRP,Ⅲburn degree TBSA and BSA were significantly positively correlated with the actually measured REE(rs=0.402,0.410,0.508,P=0.042,0.038,0.008 respectively),Hb level was significantly negatively correlated with the measured REE(rs=-0.606,P=0.001),Ⅲdegree TBSA was significantly negatively correlated with RQ(rs=-0.466,P=0.016);BSA was significantly positively correlated with expected REE(rs=0.863,P=0.000).According to the SIRS diagnostic criteria and the physiological status of the disease,SIRS occurred in 8 cases,stress hyperglycemia in 7 cases,inhalation lung injury in 12 cases and burn shock in 9 cases,and statistical analysis showed that the RQ of patients with SIRS was significantly higher than that of patients without SIRS[0.86(0.14)vs.0.81(0.14),P<0.05],indicating that the occurrence of SIRS affected RQ.Other complications had no effect on energy metabolism and RQ.Conclusion The CRP,burnⅢdegree TBSA and BSA could affect REE,and SIRS,andⅢdegree TBSA in burn patients impact their RQ,which has a certain guiding significance for nutritional support programs of burn patients.
作者
骆彬
王丹丹
杜红珍
谢颖
李增宁
Luo Bin;Wang Dandan;Du Hongzhen;Xie Ying;Li Zengning(Department of Nutrition,the First Hospital of Hebei Medical University,Shijiazhuang 050031,Hebei,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2020年第4期452-456,共5页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
河北省医药卫生科研基金项目(20150198)
河北省医学适用技术跟踪项目(G201709)。
关键词
烧伤
间接测热法
营养代谢
静息能量代谢
呼吸商
炎症
Burn injury
Indirect calorimetry
Nutrient metabolism
Resting energy metabolism
Respiratory quotient
Inflammation
