探討外科重症患者熱量需求、營養攝取狀況與臨床預後指標之相關性

The association of energy requirement, nutrient intake and clinical outcomes of patients in surgical intensive care unit.

陳奕慈(Yi-Ci Chen)

指導教授 ： 黃詩茜

中山醫學大學/健康管理學院/營養學系碩士班/碩士(2018年)

摘要

外科加護病房患者因大型手術、創傷或休克等狀況，造成體內營養消耗量增加，而常有營養不良情形發生。若未給予重症患者適當營養支持，可能延長患者使用呼吸器天數、住ICU天數、總住院天數及增加死亡率。但至今研究針對早期給予外科重症患者合適的熱量建議量範圍為何，可獲得最佳預後情形，目前尚無一致定論，因此本研究目的為1) 比較外科重症患者不同攝食情形之預後狀況之差異; 2) 評估外科重症患者營養攝取狀況與預後狀況之相關性。本研究以雙中心模式，於臺中榮民總醫院與童綜合醫療社團法人童綜合醫院收集 78 位外科加護病房患者，以Penn State 公式計算患者建議熱量需求量，並紀錄患者進入加護病房第2~7天之實際攝取量，並計算熱量攝取達標率。結果依熱量攝取達標率 70% 為切點，<70% 組患者攝取710.6 kcal，達標率為43.7%；≥70% 組患者攝取1477.3 kcal，達標率為94.3%。≥70% 組的實際攝取量、達標率、蛋白質 [(g)，(g/kg)]、脂肪、醣類 (g)、飽和脂肪酸、單元不飽和脂肪酸、多元不飽和脂肪酸、中鏈脂肪酸、糖類的攝取量皆顯著高於 <70% 組。醣類攝取 (%) 則是 <70% 組顯著高於 ≥70% 組。進一步調整性別、年齡、BMI、APACHE II後，於 <70% 組發現，熱量攝取達標率與使用總住院天數呈正相關 (β = 0.622 p = 0.013)，但這可能與患者疾病嚴重度有關。再者患者蛋白質攝取愈多，可減少總住院天數；不過，患者達標率 ≥70%，脂肪攝取愈多，可能增長停留ICU時間。

關鍵字

外科加護病房 ； 重症患者 ； 熱量攝取達標率 ； 實際營養攝取狀況 ； 臨床預後指標

並列摘要

Surgical intensive care unit (SICU) patients who have undergone a variety of general and specialty surgical procedures including all gastrointestinal procedures, trauma or coma, leading to increased nutritional consumption, and malnutrition is happened frequently. if there is no adequate nutritional support for SICU patients, it might increase the days of machine ventilator, hospitalization in the SICU, overall hospitalization, and mortality rate. However, there is no consistent result of adequate calorie range recommendation for the best clinical outcomes for SICU patients. Therefore, the purpose of this study was to compare the difference of clinical outcomes of critically ill patients according to calorie achievement rate, and assessment the relationship between the nutritional intake and clinical outcomes. This was a cross-sectional study and dual center mode, and recruited total 78 SICU patients of the Taichung Veterans General Hospital and the Tungs’ Taichung MetroHabor Hospital. The recommendation of calorie need for SICU patients based on the Penn State equation, and recorded the actual calorie intake and calculated the achievement rate on the 2st and 7th day of admission to the intensive care unit. The actual calorie intake of < 70% group was 710.6 kcal, and the calorie achievement rate was 43.7%; the actual calorie intake of ≥70% group was 1477.3kcal, and the calorie achievement rate was 94.3%. The protein (g, g/kg), fat, carbohydrate (g), saturated fatty acid, monounsaturated fatty acid, polyunsaturated fatty acid, medium chain fatty acid, and sugar intake were significant higher in the group of ≥70% than the group of achievement rate <70% calorie need met. However, the carbohydrate intake (%) was higher in the group of achievement rate <70% than the group of achievement rate ≥70%. After adjusting gender, age, BMI, APACHE II, the result showed positive relationship between calorie achievement and total days of hospitalization in < 70% group (β = 0.622 p = 0.013). The result might be related to the severe of disease. If patient had more protein intake, patient can also reduce the days of hospitalization. However, if patient in ≥ 70% group increased fat intake, patient might be increased the days of staying in the ICU.

並列關鍵字

surgical intensive care unit ； critically ill patients ； calorie achievement rate ； actual nutrition intake ； clinical outcomes.

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