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目的:比较重症神经疾病病人肠内营养(EN)能量预测目标值与实际供给值,以指导EN不足肠外营养(PN)补充的策略。方法:对2012年11月至2014年2月顺序收入神经内科ICU(NCU)的急性重症神经疾病病人进行前瞻性队列研究。全部病人首选EN。入院时,按经验估算法[104.6 k J(25 kcal)/(kg·d)]计算能量预测目标值,按EN 3 d后平均每天实际能量供给值是否达到预测目标值,分为能量达标组和能量未达标组。观察病人基线特征、能量供给、胃肠功能状态和营养状态。结果:入组病人100例,EN 3 d后平均每天能量达标组76例,未达标组24例。经多因素Logistic回归分析,仅性别是能量未达标的独立影响因素。能量达标组与能量未达标组比较,病后3个月病死率、预后不良率(mRS>4分)、NCU内新发肺炎、NCU停留时间、住院时间、出NCU时营养状况均无显著性差异。结论:NCU大多数病人实际肠内喂养值接近预测值,经TEN可以满足能量需求。少数病人实际肠内喂养值低于预测值,性别是未达标的独立影响因素。
OBJECTIVE: To compare the enteral nutrition (EN) energy prediction target value and actual supply value in patients with severe neurological disease so as to guide the strategy of EN deficient parenteral nutrition (PN) supplement. METHODS: A prospective cohort study of patients with acute severe neurological disease who received sequential neurological ICU (NCU) from November 2012 to February 2014 was conducted. All patients preferred EN. At the time of admission, the predicted target value of energy was calculated according to the empirical estimation method [104.6 k J (25 kcal) / (kg · d)]. According to whether the actual daily energy supply value reached the predicted target value after 3 days, the energy standard group And the energy does not meet the group. Observe the baseline characteristics of patients, energy supply, gastrointestinal function status and nutritional status. Results: The enrolled patients were enrolled in this study. The average energy per day after EN 3 d was 76 in the standard group and 24 in the non-compliance group. After multivariate logistic regression analysis, only gender was the independent influencing factor of energy failure. There was no significant difference in nutritional status between the NC group and the NCU group in terms of case fatality rate, poor prognosis (mRS> 4 points), new pneumonia in NCU, NCU stay time, hospital stay, difference. CONCLUSIONS: The actual enteral feeding value of most patients in NCU approaches the predicted value, and the energy requirement can be met by TEN. The actual number of intestinal feeding in a small number of patients is lower than the predicted value, sex is not independent of independent factors.