ISSN 1674-3865  CN 21-1569/R
主管：国家卫生健康委员会
主办：中国医师协会
　　　辽宁省基础医学研究所
　　　辽宁中医药大学附属医院
中国中西医结合儿科学

中国中西医结合儿科学 ›› 2021, Vol. 13 ›› Issue (5): 405-408.

• 临床研究 • 上一篇    下一篇

脓毒症患儿急性期的静息能量代谢研究

目的:危重症患儿在急性期应激反应状态下能量代谢机制尚不明确，本研究目的是明确脓毒症急性期能量代谢特点，并评估脓毒症患儿炎症因子与代谢模式之间关系，不同代谢模式患儿死亡率之间的关系。
方法:选择2017年12月至2019年6月湖南省儿童医院PICU收治的脓毒症患儿178例为研究对象，采用间接测热法测定患儿静息能量消耗（REE）。运用Schofield-HTWT公式计算入选患儿的REE预测值，根据REE与REE预测值的比值来判别患儿的代谢模式，分析不同脓毒症类型的REE，并分析代谢模式与炎症因子(C反应蛋白、降钙素原、白细胞介素-6)的关系，不同代谢模式患儿死亡率之间的关系。
结果:178例脓毒症患儿中，低代谢模式88例（49.4%），正常代谢模式71例（39.9%），高代谢模式19例（10.7%），3组比较差异无统计学意义(P>0.05)；不同脓毒症类型间的实际REE值比较差异无统计学意义（P＞0.05）；REE及REE预测值比较差异无统计学意义(P＞0.05)。氧耗量(VO-2)和二氧化碳呼出量(VCO-2)与低代谢模式有关(P<0.001)，炎症因子与低代谢模式无关(P＞0.05)。低代谢模式患儿死亡率高于其他代谢模式，但差异无统计学意义(P>0.05)。
结论:脓毒症急性应激期患儿大部分为低代谢模式，炎症因子与代谢模式无明显关系，只有VO-2和VCO-2与低代谢模式有关。低代谢组患儿的死亡率明显升高，因临床病例数过少，后期需要进一步研究。推荐间接测热法指导供给危重症患儿能量，采取合理营养干预及治疗，改善脓毒症患者的预后。   

  1. 410007 长沙，湖南省儿童医院急救中心
  • 出版日期:2021-10-25 发布日期:2021-11-18
  • 通讯作者: 罗兰，E-mail：335129775@qq.com
  • 作者简介:罗兰（1983-），女，医学硕士，副主任医师。研究方向：儿童危重症的救治
  • 基金资助:
    湖南省卫生健康委员会科研计划课题项目（B20180371）

Study on resting energy expenditure of children with sepsis at acute stage

Objective:The mechanism of energy metabolism in critically ill children with sepsis is not clear. The purpose of this study is to make clear the characteristics of energy metabolism in acute phase of sepsis，and to assess the relationship between inflammatory factor and metabolism mode in septic children，and the difference in the mortality rate among different modes.#br# Methods:A total of 178 children with sepsis who were admitted to PICU of Hunan Children's Hospital from December 2017 to June 2019 were prospectively collected as the study subjects. The resting energy expenditure(REE) of the children was measured by indirect calorimetry. The predicted resting energy expenditure(PREE) was calculated with Schofield-HTWT formula. The metabolic mode was decided according to the ratio of REE to PREE. The REE was analyzed in different types of sepsis. The relationship between metabolic mode and inflammatory factors(CRP, PCT and IL-6) was analyzed. The relationship of metabolic mode with mortality was also analyzed.#br# Results:Among 178 children with sepsis， there were 87（49.4%） with hypometabolic pattern，71（39.9%） with normal metabolic pattern，and 19（10.7%） with hypermetabolic pattern(P>0.05). There was no significant difference in REE among different types of sepsis(P>0.05). REE showed no significant difference from predicted values(P>0.05). Only oxygen consumption(VO-2) and carbon dioxide production(VCO-2) were associated with hypometabolic pattern(P<0.001)，while inflammatory factors were not associated with hypometabolic pattern(P>0.05). The mortality rate of the hypometabolic pattern group was higher than other metabolic patterns，，but there was no statistical significance(P>0.05).#br# Conclusion:Most of the children with acute phase of sepsis are with hypometabolic pattern，and inflammatory factors have no significant relationship with metabolism mode; only VO-2 and VCO-2 are related to hypometabolic pattern. There is a significant increase in mortality in children with hypometabolic pattern，due to small number of cases，further study is needed in the future. Therefore, individualized nutrition supply is recommended for critically ill children, and indirect calorimetry is recommended to guide the supply, so as to facilitate the adoption of reasonable nutritional intervention and treatment, in order to improve the prognosis of patients with sepsis.   

  1. Emergency Center，Hunan Children Hospital，Changsha 410007，China
  • Online:2021-10-25 Published:2021-11-18

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摘要： 目的:危重症患儿在急性期应激反应状态下能量代谢机制尚不明确，本研究目的是明确脓毒症急性期能量代谢特点，并评估脓毒症患儿炎症因子与代谢模式之间关系，不同代谢模式患儿死亡率之间的关系。
方法:选择2017年12月至2019年6月湖南省儿童医院PICU收治的脓毒症患儿178例为研究对象，采用间接测热法测定患儿静息能量消耗（REE）。运用Schofield-HTWT公式计算入选患儿的REE预测值，根据REE与REE预测值的比值来判别患儿的代谢模式，分析不同脓毒症类型的REE，并分析代谢模式与炎症因子(C反应蛋白、降钙素原、白细胞介素-6)的关系，不同代谢模式患儿死亡率之间的关系。
结果:178例脓毒症患儿中，低代谢模式88例（49.4%），正常代谢模式71例（39.9%），高代谢模式19例（10.7%），3组比较差异无统计学意义(P>0.05)；不同脓毒症类型间的实际REE值比较差异无统计学意义（P＞0.05）；REE及REE预测值比较差异无统计学意义(P＞0.05)。氧耗量(VO-2)和二氧化碳呼出量(VCO-2)与低代谢模式有关(P<0.001)，炎症因子与低代谢模式无关(P＞0.05)。低代谢模式患儿死亡率高于其他代谢模式，但差异无统计学意义(P>0.05)。
结论:脓毒症急性应激期患儿大部分为低代谢模式，炎症因子与代谢模式无明显关系，只有VO-2和VCO-2与低代谢模式有关。低代谢组患儿的死亡率明显升高，因临床病例数过少，后期需要进一步研究。推荐间接测热法指导供给危重症患儿能量，采取合理营养干预及治疗，改善脓毒症患者的预后。

关键词: 脓毒症, 静息能量代谢, 儿童

Abstract: Objective:The mechanism of energy metabolism in critically ill children with sepsis is not clear. The purpose of this study is to make clear the characteristics of energy metabolism in acute phase of sepsis，and to assess the relationship between inflammatory factor and metabolism mode in septic children，and the difference in the mortality rate among different modes.
Methods:A total of 178 children with sepsis who were admitted to PICU of Hunan Children's Hospital from December 2017 to June 2019 were prospectively collected as the study subjects. The resting energy expenditure(REE) of the children was measured by indirect calorimetry. The predicted resting energy expenditure(PREE) was calculated with Schofield-HTWT formula. The metabolic mode was decided according to the ratio of REE to PREE. The REE was analyzed in different types of sepsis. The relationship between metabolic mode and inflammatory factors(CRP, PCT and IL-6) was analyzed. The relationship of metabolic mode with mortality was also analyzed.
Results:Among 178 children with sepsis， there were 87（49.4%） with hypometabolic pattern，71（39.9%） with normal metabolic pattern，and 19（10.7%） with hypermetabolic pattern(P>0.05). There was no significant difference in REE among different types of sepsis(P>0.05). REE showed no significant difference from predicted values(P>0.05). Only oxygen consumption(VO-2) and carbon dioxide production(VCO-2) were associated with hypometabolic pattern(P<0.001)，while inflammatory factors were not associated with hypometabolic pattern(P>0.05). The mortality rate of the hypometabolic pattern group was higher than other metabolic patterns，，but there was no statistical significance(P>0.05).
Conclusion:Most of the children with acute phase of sepsis are with hypometabolic pattern，and inflammatory factors have no significant relationship with metabolism mode; only VO-2 and VCO-2 are related to hypometabolic pattern. There is a significant increase in mortality in children with hypometabolic pattern，due to small number of cases，further study is needed in the future. Therefore, individualized nutrition supply is recommended for critically ill children, and indirect calorimetry is recommended to guide the supply, so as to facilitate the adoption of reasonable nutritional intervention and treatment, in order to improve the prognosis of patients with sepsis.

Key words: Sepsis, REE, Children