利用不同之營養狀況指標評估使用呼吸器之重症病患能量的需要

前言：住院病患普遍存在營養不良的問題，特別是使用呼吸器的重症病患。研究顯示攝食不足與過度攝食會延長脫離呼吸器及住院天數。本研究的主要目的是利用不同之營養狀況指標，評估使用呼吸器之重症病患能量的需要。 方法：本實驗受測者共有78位重症病患，使用呼吸器至少8天以上。營養狀況於病患進入加護病房的第l天及第8天，根據病患體位測量、生化檢驗、飲食攝取、營養狀況指標及醫療紀錄進行評估。並且利用間接能量測定法，測量病患的靜止能量消耗，以靜止能量消耗的120﹪定義為總能量需要。根據病患的實際能量攝取將病患分為3組：攝食不足組（實際攝取能量小於總能量需要的90%以下）有33人；攝食適當組（實際攝取能量在總能量需要的±10%範圍）有25人； 過度攝食組（實際攝取能量大於總能量需要110%以上）有20人。 結果：攝食不足病患平均僅攝取總能量需要的59﹪；而過度攝食組病患約攝取總能量需要的134﹪。三組病患平均氮平衡呈負值，在攝食適當病患組，平均負氮平衡的數值在第8天有明顯的改善，並且攝食適當組病患，住進加護病房的第8天平均營養狀況指標值Maastricht index較第1天有顯著的改善（6.5±2.9 vs. 5.2±2.2）。 結論：本研究結果顯示攝食適當組較其他組在住加護病房第8天後可顯著改善其營養狀況，因此使用呼吸器的重症病患，最適當的能量攝取為靜止能量消耗的120%。

Background: The prevalence of malnutrition is a common problem in hospitalized patients, especially in critically ill patients who are being ventilated mechanically. Studies have shown that underfeeding and overfeeding may prolong the length of weaning from mechanical ventilation and hospital stay. The purpose of this study was to estimate energy requirements for mechanically ventilated, critically ill patients using nutritional status indicators. Methods: Patients were dynamically stable, mechanically ventilated, critically ill patients and were requiring at least 8 days of mechanical ventilation. Seventy-eight patients successfully completed this study. Nutritional status was assessed according to patients’ anthropometrical and biochemical measurements, daily nutrient intakes, nutritional status indices. Medical status was assessed on the 1st day and 8th day of admission in the intensive care unit. Resting energy expenditure was measured using indirect calorimetry. Total energy requirement was considered 120% of the measured resting energy expenditure. Thirty-three patients were being underfed (<90% of total energy requirement), 25 patients were in the appropriate feeding group (within ± 10% of total energy requirement), and 20 patients received overfeeding (>110% of total energy requirement). Results: Patients in the underfeeding group received only 59 % of their energy requirement, while the overfeeding group patients received up to 134 % of their required calories. Patients in all groups had a negative mean nitrogen balance. However, only patients in the appropriate feeding improved their nitrogen balance by day 8 of admission, and had a significantly improved in nutritional status index (Maastricht index) on day 8 than on day 1. (6.5±2.9 vs. 5.2±2.2) Conclusion: Appropriate feeding group had improved significantly in nutritional status than patients in the other feeding groups on day 8. To provide 120% of the measured resting energy expenditure seemed adequate to meet the energy requirements of dynamically stable, mechanically ventilated, critically ill patients.