摘要目的 观察重型颅脑损伤患者的营养支持情况,分析累积能量平衡与预后的关系.方法 选择重症监护病房(ICU)中56例重型颅脑损伤患者,记录每日摄入热量,计算能量平衡,比较营养生化指标变化；用Logistice回归分析累积能量平衡影响预后的情况.结果 全部患者实际摄入能量为(5966±1973) kJ/d,能量负平衡为(822±314) kJ/d.前3d能量负平衡最严重,实际摄入能量值明显低于目标能量值[(3258±1280) kJ vs(5977±976)kJ,P＜0.05)],随时间延长,实际摄入能量值逐渐上升,前14 d是发生能量负平衡的主要时期.与入院3d比较,患者7d时血浆血蛋白下降最为明显[(28.0±5.5)g/L vs (36.5±4.2) g/L,P＜0.05)],随后逐渐升高,至28 d时已恢复至正常水平[(36.2±3.2) g/L].入院3d前白蛋白[(122.8±18.8)mg/L]明显低于正常水平,7d时[(209.8±33.6) mg/L]即明显升高(P＜0.05),并维持至28 d[(281.2±24.3)mg/L].入院3dC-反应蛋白[(135.9±44.4) mg/L]明显高于正常水平,7d时[(110.2 ±36.7)mg/L]即明显下降(P＜0.05),随后呈逐渐下降趋势.Logistic回归分析显示,累积能量负平衡与感染和上消化道出血等并发症相关[感染的优势化(OR值)2.129,95％可信区间(95％ CI:1.528,29.886),P=0.023;上消化道出血的OR值0.091,95％ CI:0.013,0.545,P=0.009].结论 累积能量负平衡与重型颅脑损伤患者的并发症相关；及早补充足够的能量,可改善患者的预后.

abstractsObjective To observe the energy expenditure in severe traumatic brain injury patients,and to assess the impact of cumulative energy balance on clinical outcomes.Methods Using prospective self-controlled study,the changes of energy expenditure in 56 patients with severe traumatic brain injury were measured.Daily energy intake was recorded.Afterwards,energy balance was calculated.The relationship between cumulative energy balance and clinical outcomes was analyzed.Results Mean practical energy intake of all patients was (5966 ± 1973)kJ/d,and mean negative energy balance was (822 ± 314) kJ/d.The negative energy balance was most crucial in first 3 days after administration.Meanwhile,practical energy intake was significantly lower than target energy intake [(3258±1280)kJ vs (5977±976)kJ,P ＜0.05].The practical energy intake was increased with time,and the first 14 days were crucial for development of negative energy balance.On the 7th day after administration,the level of plasma albumin was significantly lower compared with that on 3 rd [(28.0 ±5.5)g/L vs (36.5 ±4.2)g/L,P ＜0.05],and then increased gradually and returned to normal level on 28 days [(36.2 ± 3.2)g/L].Three days after administration,prealbumin[122.8 ± 18.8)mg] was significantly lower than normal level,but elevated rapidly on the 7 th day[(209.8 ±33.6) mg/L,P ＜0.05] and continuously increased till 28 th day[(281.2 ±24.3)mg/L].On the 3 rd day after administration,C-reactive protein [(135.9 ±44.4) mg/L] was significantly higher than normal level; however,it significantly decreased on the 7 th day[(110.2 ± 36.7)mg/L,P ＜0.05],and continuously decreased.Logistic regression analysis showed a strong association of cumulative negative energy balance with infection and upper gastrointestinal bleeding [odds ratio [(OR) of infection was 2.129,95 ％ confidence interval (95％ CI 1.528 to 29.886,P =0.023 ; OR of upper gastrointestinal bleeding was 0.091,95％ CI0.013 to 0.545,P =0.009].Conclusions Cumulative negative energy balance may be correlated with the occurrence of complications of patients with severe traumatic brain injury,early supply of sufficient energy may improve the outcome of patients.