Investigation and analysis of protein and energy intake in adult patients with severe burns
-
摘要: 目的 调查分析严重烧伤成年患者伤后3~14 d能量和蛋白质实际摄入状况。 方法 回顾性分析天津市第一中心医院整形与烧伤外科2011年1月1日—2017年12月31日收治的符合入选标准的52例严重烧伤成年患者[男37例、女15例,年龄(37±9)岁]资料,根据重症护理记录统计患者伤后3~14 d膳食、肠内营养制剂和肠外营养制剂的摄入情况。计算并比较患者伤后3~7、8~14 d每人每日摄入总能量及其占目标能量的比例;每人每日三大营养素(碳水化合物、脂肪、蛋白质)摄入量和其提供能量占摄入总能量的比例和热氮比;每人每日由膳食、肠内营养制剂、肠外营养制剂途径摄入的能量和摄入蛋白质量,每人每日经以上3种途径摄入能量占摄入总能量的比例及摄入蛋白质量占摄入总蛋白质量的比例。记录患者伤后3~7、8~14 d呕吐及腹泻情况。记录或计算患者伤后7、14 d血清白蛋白、前白蛋白、血糖、甘油三酯水平及24 h尿氮排出量、氮平衡值。对数据行配对
t 检验、χ 2检验。 结果 (1)本组患者伤后3~7 d每人每日摄入总能量(8 696±573)kJ,为目标能量(13 290±1 561)kJ的65.4%;伤后8~14 d每人每日摄入总能量(11 980±1 259)kJ,为目标能量的90.1%。患者伤后3~7 d每人每日摄入总能量明显低于伤后8~14 d(t =18.172,P <0.01)。(2)本组患者伤后8~14 d每人每日碳水化合物、脂肪、蛋白质摄入量均明显高于伤后3~7 d(t =15.628、22.231、10.403,P <0.01)。本组患者伤后3~7 d每人每日由碳水化合物、脂肪、蛋白质提供能量占摄入总能量的56.8%、25.1%、18.3%,伤后8~14 d每人每日由碳水化合物、脂肪、蛋白质提供能量占摄入总能量的54.2%、27.0%、18.7%。本组患者伤后3~7、8~14 d每人每日由三大营养素提供能量占摄入总能量的构成比相近(χ 2=0.185,P >0.05)。本组患者伤后3~7、8~14 d热氮比(kJ∶g)分别为469∶1、456∶1。(3)本组患者伤后8~14 d每人每日经膳食、肠外营养制剂途径摄入的能量分别为(4 394±978)、(5 723±898)kJ,明显高于伤后3~7 d的(2 137±453)、(4 855±825)kJ(t =26.516、6.583,P <0.01);而本组患者伤后8~14 d和伤后3~7 d每人每日经肠内营养制剂途径摄入的能量相近(t =1.922,P >0.05)。本组患者伤后3~7、8~14 d每人每日经膳食、肠内营养制剂、肠外营养制剂途径摄入的能量占摄入总能量的构成比相近(χ 2=4.100,P >0.05)。本组患者伤后8~14 d每人每日经膳食途径摄入蛋白质量为(58±22)g,明显高于伤后3~7 d的(25±6)g(t =14.514,P <0.01);而经肠内、肠外营养制剂途径摄入蛋白质量与伤后3~7 d的相近(t =1.924、1.110,P >0.05)。本组患者伤后3~7、8~14 d每人每日经膳食和肠内、肠外营养制剂途径摄入蛋白质量占摄入总蛋白质量的构成比相近(χ 2=5.634,P >0.05)。(4)伤后3~7 d有3例患者出现呕吐,4例患者出现腹泻;伤后8~14 d有1例患者出现呕吐和腹泻。本组患者伤后7、14 d血清白蛋白、前白蛋白、血糖、甘油三酯、24 h尿氮排出量、氮平衡值分别为(29±4)、(30±4)g/L,(132±42)、(171±48)mg/L,(7.4±2.8)、(6.7±2.8)mmol/L,(1.5±0.7)、(1.4±0.7)mmol/L,(30.5±4.3)、(34.5±2.2)g,-(25.1±2.6)、-(23.7±3.9)g。 结论 严重烧伤成年患者伤后3~7 d每人每日摄入总能量低于伤后8~14 d,伤后3~7、8~14 d每人每日由三大营养素提供能量占摄入总能量的构成比相近。患者伤后3~7 d摄入的能量、蛋白质主要来源于肠外营养制剂;伤后8~14 d摄入的能量、蛋白质主要来源于肠外营养制剂和膳食。Abstract: Objective To investigate and analyze the actual intake of protein and energy in adult patients with severe burns during post burn days (PBDs) 3 to 14. Methods Records of 52 adult patients with severe burns [37 males and 15 females, (37±9) years old], admitted to the Department of Plastic Surgery and Burns of Tianjin First Central Hospital from January 1st 2011 to December 31st 2017 and meeting the study inclusion criteria, were retrospectively analyzed. Nutrition intake from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations of patients during PBDs 3 to 14 were obtained from critical care records. During PBDs 3 to 7 and PBDs 8 to 14, the personal daily total energy intake and the ratio of it to energy target of patients were calculated and compared; the personal daily intake of carbohydrate, fat, and protein and calorigenic percentages of carbohydrate, fat, and protein accounted for total energy intake, and the ratios of non-protein calories to total nitrogen of patients were calculated and compared; the personal daily energy and protein intake of patients from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations were analyzed; the percentages of energy intake from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations accounted for total energy intake, and the percentages of protein intake from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations accounted for total protein intake of patients were calculated. Vomiting and diarrhea of patients during PBDs 3 to 7 and PBDs 8 to 14 were recorded. Levels of serum albumin, prealbumin, blood glucose, and triglycerides, 24-hour excretion of urinary nitrogen, nitrogen balance values of patients on PBDs 7 and 14 were recorded or calculated. Data were processed with pairedt test and chi-square test. Results (1) The personal daily total energy intake of patients during PBDs 3 to 7 and PBDs 8 to 14 were (8 696±573) and (11 980±1 259) kJ respectively, and ratios of them to energy target [(13 290±1 561) kJ] were 65.4% and 90.1% respectively. The personal daily total energy intake of patients during PBDs 3 to 7 was obviously lower than that during PBDs 8 to 14 (t =18.172,P <0.01). (2) The personal daily intake of carbohydrate, fat, and protein of patients during PBDs 8 to 14 were obviously higher than those during PBDs 3 to 7 (t =15.628, 22.231, 10.403,P <0.01). The personal daily calorigenic percentages of carbohydrate, fat, and protein accounted for total energy intake of patients were 56.8%, 25.1%, and 18.3% respectively during PBDs 3 to 7 and 54.2%, 27.0%, and 18.7% respectively during PBDs 8 to 14. The calorigenic constituent ratio of personal daily intake of carbohydrate, fat, and protein accounted for total energy intake of patients during PBDs 3 to 7 was close to that during PBDs 8 to 14 (χ 2=0.185,P >0.05). The ratios of non-protein calories to total nitrogen (kJ∶g) of patients during PBDs 3 to 7 and PBDs 8 to 14 were 469∶ 1 and 456∶ 1 respectively. (3) The personal daily energy intake of patients from routes of oral diet and parenteral nutrition preparations during PBDs 8 to 14 [(4 394±978), (5 723±898) kJ] were obviously higher than those during PBDs 3 to 7 [(2 137±453), (4 855±825) kJ,t =26.516, 6.583,P <0.01], while the personal daily energy intake of patients from routes of enteral nutrition preparations during PBDs 8 to 14 was close to that during PBDs 3 to 7 (t =1.922,P >0.05). The constituent ratio of personal daily energy during PBDs 3 to 7 was close to that during PBDs 8 to 14 (χ 2=4.100,P >0.05). The personal daily protein intake of patients from route of oral diet during PBDs 8 to 14 was (58±22) g, obviously higher than (25±6) g during PBDs 3 to 7 (t =14.514,P <0.01). The personal daily protein intake of patients from routes of enteral nutrition preparations and parenteral nutrition preparations during PBDs 8 to 14 was close to those during PBDs 3 to 7 (t =1.924, 1.110,P >0.05). The constituent ratio of personal daily protein intake from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations accounted for total protein intake during PBDs 8 to 14 was close to that during PBDs 3 to 7 (χ 2=5.634,P >0.05). (4) There were 3 patients with vomiting and 4 patients with diarrhea during PBDs 3 to 7, and 1 patient experienced both of them during PBDs 8 to 14. The levels of serum albumin, prealbumin, blood glucose, and triglycerides, 24-hour excretion of urinary nitrogen, and nitrogen balance values of patients on PBDs 7 and 14 were (29±4) and (30±4) g/L, (132±42) and (171±48) mg/L, (7.4±2.8) and (6.7±2.8) mmol/L, (1.5±0.7) and (1.4±0.7) mmol/L, (30.5±4.3) and (34.5±2.2) g, -(25.1±2.6) and -(23.7±3.9) g, respectively. Conclusions The personal daily total energy intake of patients during PBDs 3 to 7 was lower than that during PBDs 8 to 14. The calorigenic constituent ratio of personal daily intake of carbohydrate, fat, and protein accounted for total energy of patients during PBDs 3 to 7 was close to that during PBDs 8 to 14. Energy and protein intake were mostly derived from parenteral nutrition preparations during PBDs 3 to 7, while those during PBDs 8 to 14 were mainly derived from parenteral nutrition preparations and oral diet.-
Key words:
- Burns /
- Nutrition surveys /
- Energy intake /
- Proteins
点击查看大图
计量
- 文章访问数: 33
- HTML全文浏览量: 5
- PDF下载量: 21
- 被引次数: 0