摘要
目的评估使用间接测热法(indirect calorimetry,IC)获得的24 h能量消耗值在多发伤机械通气患者预后中的预测作用。方法选取2016年12月1日至2018年8月31日宁夏医科大学总医院ICU住院治疗的140例多发伤机械通气患者作为研究对象,记录患者的性别、年龄、身高、体质量和临床诊断等一般资料;使用IC法测量患者的24 h能量消耗,使用24 h能量消耗与患者实际体质量的比值计算出每千克体质量24 h能量消耗;对患者机械通气时间、ICU住院天数进行统计分析,以预后28 d是否死亡、是否发生院内感染为结局指标,采用受试者工作特征曲线(ROC曲线)分析24 h能量消耗和每千克体质量24 h能量消耗的预测价值。结果机械通气时间与多发伤患者24 h能量消耗、每千克体质量24 h能量消耗成正相关(r=0.470,r=0.247,均P<0.01);ICU住院日与多发伤患者24 h能量消耗成正相关(r=0.276,P<0.05)。IC法测得的24 h能量消耗、每千克体质量24 h能量消耗对28 d病死率和院内感染发生率预后评价的ROC曲线下面积(AUC)分别为0.647、0.663、0.832、0.646,以每千克体质量24 h能量消耗大于30.4 kcal/(kg·d)(1 kcal=4.184 kJ)作为判断28 d病死率的最佳截断值,其敏感度为66.5%,特异度为77.0%,以24 h能量消耗大于2083 kcal/d作为判断是否易发院内感染的最佳截断值,其敏感度为80.0%,特异度为80.7%。结论多发伤患者机械通气时间、ICU住院时间与能量消耗密切相关;每千克体质量24 h能量消耗和24 h能量消耗对多发伤患者预后一定的预测作用,24 h能量消耗大于2083 kcal/d的多发伤患者,院内感染的发生率可能升高。
Objective To evaluate the predictive effect of the 24 h energy expenditure value obtained by indirect calorimetry(IC)on the prognosis of patients with multiple traumatic mechanical ventilation.Methods A total of 140 patients with multiple traumatic mechanical ventilation who were hospitalized in the ICU of General Hospital of Ningxia Medical University from December 1st,2016 to August 31st,2018 were selected as research objects.The general information such as sex,age,Height,weight,and clinical diagnosis were recorded.The IC method was used to measure the patient's 24 h energy expenditure,and the ratio of 24 h energy expenditure to the actual body weight of the patients was calculated the energy expenditure of 24 h energy expenditure per kilogram of body weight.The patient’s mechanical ventilation time and length of stay in ICU were statistically analyzed.The outcome indexes were 28-day mortality and the incidence of hospital-acquired infection.The receiver operating characteristic curve(ROC)was used to analyze the predictive value of 24 h energy expenditure and 24 h energy expenditure per kilogram of body weight.Results The mechanical ventilation time was positively correlated with 24 h energy expenditure and 24 h energy expenditure per kilogram of body weight(r=0.470,r=0.247,both P<0.01).The length of sty in ICU was positively correlated with the 24 h energy expenditure of patients with multiple trauma(r=0.276,P<0.05).The area under the ROC curve(AUC)of the 24 h energy expenditure and 24 h energy expenditure per kilogram of body weight for the 28 d mortality and the incidence of hospital-acquired infection were 0.647,0.663,0.832,0.646,with the 24 h energy expenditure per kilogram of body weight greater than 30.4 kcal/(kg·d)as the best critical value for judging 28 d mortality.The sensitivity was 66.5%,specificity was 77.0%,and the 24 h energy expenditure consumption greater than 2083 kcal/d was used as the optimal critical value for judging the susceptibility to acquire hospital infection,with a sensitivity o
作者
王丽娟
朱金源
赵兰菊
马国荣
马希刚
Wang Lijuan;Zhu Jinyuan;Zhao Lanju;Ma Guorong;Ma Xigang(Department of Neurology,Cardiovascular and Cerebrovascular Hospital,General Hospital of Ningxia Medical University,Yinchuan 750002,China;Department of Critical Care Medicine,General Hospital of Ningxia Medical University,Yinchuan 750004,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2020年第5期670-674,共5页
Chinese Journal of Emergency Medicine
基金
宁夏回族自治区自然科学基金(NZ17163)。
关键词
多发伤
机械通气
能量消耗
IC法
院内感染
Multiple trauma
Mechanical ventilation
Energy expenditure
IC method
Hospital-acquired infection
