摘要：
Objective To analyze the resting energy expenditure and optimal energy supply in different age groups of critically ill children on mechanical ventilation in pediatric intensive care unit (PICU).Methods Patients on mechanical ventilation hospitalized in PICU of Beijing Children's Hospital from March 2015 to March 2016 were enrolled prospectively.Resting energy expenditure of patients was calculated by US Med Graphic company critical care management (CCM) energy metabolism test system after mechanical ventilation.Patients were divided into three groups:＜3 years,3-10 years,and ＞10 years.The relationship between the measured and predictive resting energy expenditure was analyzed with correlation analysis;while the metabolism status and the optimal energy supply in different age groups were analyzed with chi square test and variance analysis.Results A total of 102 patients were enrolled,the measured resting energy expenditure all correlated with predictive resting energy expenditure in different age groups (＜3 years (r=0.3,P=0.0);3～10 years (r=0.6,P=0.0);＞10 years (r=0.5,P=0.0)).A total of 40 cases in ＜ 3 years group,including:14 cases of low metabolism (35％),14 cases of normal metabolism (35％),and 12 cases of high metabolism (30％);45 cases in 3-10 years group,including:22 cases of low metabolism (49％),19 cases of normal metabolism (42％),4 cases of high metabolism (9％);17 cases in＞10 years group,including:12 cases of low metabolism (71％),4 cases of normal metabolism (23％),1 case of high metabolism (6％).Metabolism status showed significant differences between different age groups (x2=1 1.30,P＜0.01,r=-0.01).Infants had higher metabolic status,which lessened with aging.The total average actual energy requirement was (210±84) kJ/(kg·d).There were significant differences in actual energy requirement between age groups (F=46.57,P＜0.001),with (277±77) kJ/(kg·d) in＜3 years group,(184±53) kJ/(kg·d)in 3-10 years group,and (120±30) kJ/(kg· d) in＞10 years group.Conclusion The resting energy metabolism of the critically ill children on mechanical ventilation is negatively related to the age.The actual energy requirement should be calculated according to different ages.%目的 了解儿童重症监护病房(PICU)机械通气危重症患儿的静息能量消耗特点,分析能量代谢状态与年龄的关系,以及不同年龄段的适宜能量供给值差异,以期为优化营养支持治疗提供依据.方法 前瞻性收集2015年3月至2016年3月入住北京儿童医院PICU的机械通气危重症患儿102例作为研究对象,采用美国MEDGRAPHIC公司生产的代谢车(CCM)测量患儿静息能量消耗.根据年龄将入选患儿分为＜3岁组(40例),3～10岁组(45例),＞10岁组(17例),应用相关分析、x2检验、方差分析等分析不同年龄组静息能量实测值与预测值、能量代谢状态与不同年龄段的关系,以及不同年龄段的适宜能量供给值差异.结果共有102例患儿入选,不同年龄组静息能量实测值与预测值均相关,＜3岁组(r=0.3,P=0.0),3～10岁组(r=0.6,P=0.0),＞10岁组(r=0.5,P=0.0);年龄＜3岁组中低代谢14例(35％),正常代谢14例(35％),高代谢12例(30％);3～10岁组中低代谢22例(49％),正常代谢19例(42％),高代谢4例(9％);＞10岁组中低代谢12例(71％),正常代谢4例(23％),高代谢l例(6％),不同年龄的代谢状态分布差异有统计学意义(x2=1 1.30,P＜0.01,r=-0.01).高代谢以婴幼儿为主,随着年龄的增加,代谢状态降低;实际能量需要总平均值(210±84)kJ/(kg·d),＜3岁组(277±77)kJ/(kg·d),3～10岁组(184±53)kJ/(kg·d),＞10岁组(120±30)kJ/(kg·d),不同年龄段的实际能量需要值均值差异有统计学意义(F=46.57,P＜0.001),随着年龄的增加,实际能量需要值降低.结论 机械通气危重症患儿的静息能量代谢与年龄相关,随着年龄的增加,代谢状态降低;不同年龄段的适宜能量供给值差异有统计学意义.
