胃肠道手术患者能量需要的研究

Energy requirement of patients after gastrointestinal surgery

  • 摘要: 目的 探讨胃肠道术后患者能量需要量。方法 选择胃肠道手术患者203例,术前采用MedGeM床旁代谢仪测定静息能量消耗(REE),收集术后临床资料,计算术后提供的平均能量,与REE×1.2×1.1(能量供给参考值SEE)比较,分为<90%SEE,90%-110%SEE,>110%SEE三组,比较三组人群术前术后人体测量指标、握力、生化指标、免疫营养指标、主观全面营养评定结果(SGA)等。结果 术后90%-110%SEE组上臂肌围、左右手握力、血肌酐、血清镁和磷均显著高于其他两组(P<0.05),平均住院日和术后停止胃肠减压时间、恢复排便时间和拆线时间与其他两组比较显著缩短(P<0.05),且SGA评分正常者显著增加(P<0.05),营养不良者显著降低(P<0.05)。同一组手术前后比较,90%-110%SEE组除血清白蛋白、血红蛋白水平较术前显著下降外(P<0.05),其他各项指标术前术后无显著性差异(P>0.05)。90%-110%SEE范围相当于(1.20±0.15)倍Harris-Benedict公式预测值、(27.22±3.95)倍理想体重和(26.00±3.93)倍实际体重。结论 以代谢仪测定结果为基准的90%-110%SEE范围可作为胃肠道术后患者的能量需要参考,如果不能进行实际测量,可根据HB公式1.2倍系数或理想体重27倍系数推断。

     

    Abstract: Objective To study the energy requirement of patients after gastrointestinal surgery. Methods Rest energy expenditure(REE) in 203 patients before gastrointestinal surgery was assayed by indirect calorimetry(MedGem).Average energy intake in these patients after gastrointestinal surgery was calculated and compared to the value 1.2×1.1×REE(SEE) and divided into <90% SEE group(low energy supplement group),90%-110% SEE group(medium energy supplement group) and >110% SEE group(high energy supplement group).Anthropometry,grip strength,biochemical and immune indices,subjective global assessment(SGA) were observed. Results The MAMC,grip strength,serum creatinine,magnesium,phosphorus were higher in 90%-110% SEE group than in the other two groups after surgery(P<0.05).The level of SGA in 90%-110% SEE group was higher than in the other two groups(P<0.05).Although significant differences were observed in blood albumin and hemoglobin of 90%-110% SEE group before and after operation(P<0.05),no significant difference was found in the other indices.The value of 90%-110% SEE was equivalent to(1.20±0.15)×Harris-Benedict(HB) equation,(27.22±3.95)×ideal body weight(kg)(IBW),and(26.00±3.93)×real body weight(kg)(RBW). Conclusion Energy intake of 90%-110% SEE or 1.2HB,27IBW may be appropriate in patients with gastrointestinal surgery.

     

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