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严重烧伤病人能量消耗的监测及营养护理 |
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刘翠梅 解海燕 王淑君 张晓影
摘要 目的：监测烧伤病人的静息能量消，以了解烧伤后能量变化的规律。方法：>30%全身体表面积烧伤的病人21例，按切痂时间早晚分组，通过代谢车测定静息能量消耗。结果：静息能量消耗高峰维持在伤后7～21天，随创面封闭及愈合逐步减少。休克期切痂植皮病人术后静息能量消耗明显低于非休克期切痂植皮病人。结论：烧伤病人伤后7～21天是临床营养治疗及护理的重点阶段，休克期切痂植皮及早封闭创面是降低高代谢的有效手段。
关键词 烧伤 静息能量消耗 代谢监测
The Measurement of Energy Expenditure of Severe Burn Patients
Liu Cui-mei Xie Hai-yan Wang Shu-jun
（Burns Institute of 304th Hosptital,Beijing,China,100037）
Abstract Objective:To investigate the dynamic changes of energy expenditure of severe burn patients.Methods:21 patients with burns over 30% of the total body surface area were monitored by cardiorespiratory diagnostic systems (Medical Graphics Corporation,USA) at patients' bedsides .21 adult males were assigned to two treatment groups.The clinical conditions and non-operative management in two groups were comparable,but different in time of eschar excision and skin grafting.Results:With the increase in burn size,the REEs elevated correspondingly,and sustained to a peak duing 7～21 days postburn.The elevated REE would decrease slowly following the wound healing.Although an increase in REE was observed in all patients,the patients with eacharectomy during burn shock stage had lower REEs than those with escharectomy after burn shock stage.Conclusion:In severe burn patients,it is important to enhance nutrition support during 7-21 days postburn.And escharectomy during burn shock stage contributes to decreasing the hypermetabolic response to burn injury.Therefore,the postburn dynamic orderliness of nutritious requirement for major burn patients will be mastered,then appropriate nutritious scheme can be adjusted by the REE value in time
Key words Burns Resting energy expenditure Measurement of metabolism
高代谢反应是严重烧伤后的一个基本特征，引起伤后高代谢的主要原因来自创面，烧伤病人的代谢率随烧伤面积的增加而升高。［1］不同治疗阶段和不同个体的实际能量消耗与营养需要有很大差异，为使营养支持个体化，有必要掌握烧伤病人能量消耗的动态变化。我科对21例严重烧伤病人应用代谢车动态监测能量消耗变化，指导临床营养治疗。
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