中文摘要：

目的 观察给脓毒症患者提供不同水平的目标能量对其预后及并发症的影响.方法 采用前瞻性随机对照单盲研究,应用间接测热法监测重症监护病房（iCU）158例脓毒症患者的静息能量消耗,将患者按随机数字表法分为3组,A、B、C组分别以静息代谢值＜90％、90％～ 110％、＞110％作为营养目标值,分析各组能量摄入、机械通气时间、院内感染发生率及28 d、60d生存率.结果入住ICU前7d每天能量摄入情况：A、B、C组能量目标值（kJ/d：7 075.0±1 046.5、5 667.8±1 908.8、4 428.8±1 377.8）、实际摄入能量（kJ/d：4 671.6±1 205.6、5655.3±1 373.0、6053.0±1 557.2）、肠内能量摄入量（kJ/d：2051.1±1046.5、3980.9±1 586.5、5 337.2±2 921.8）、平均摄入率[（66.0±15.8）％、（100.0±5.7）％、（134.0±19.7）％]两两比较差异均有统计学意义（均P＜0.05）；C组肠外能量补充量明显高于A组、B组（J/d：2 055.3±273.4比427.0±273.4、473.0±332.0,均P＜0.05）；3组间静脉葡萄糖输液所提供能量及异丙酚所供应的能量比较差异无统计学意义.B组机械通气时间短于A组和C组（d：8.4±6.3比11.0±8.2、17.8±13.0,P＞0.05和P＜0.05）,ICU住院时间也短于A组和C组（d：11.0±6.4比14.9±9.6、17.8±13.0,P＞0.05和P＜0.05）.A、B、C组总住院时间（d：32.0±22.5、26.8±7.0、30.4±21.4）以及院内感染发生率[91.1％（51/56）、84.0％（42/50）、90.4％（47/52）]两两比较差异均无统计学意义（均P＞0.05）.生存曲线分析显示：3组28 d生存率差异无统计学意义（F=3.145,P=0.076）;A组、C组60d生存率呈明显下降趋势,其中C组下降趋势更为明显（F=9.284,P=0.010）.结论对脓毒症患者早期无论是高热量或是低热量提供能量,其长期预后均不利,而恰当的目标能量供应可减少并发症,提高长期生存率.

英文摘要：

Objective To observe the impact of the diverse caloric energy intake on the outcomes and occurrence rate of complications in septic patients. Methods A prospective single-blind randomized controlled trial was conducted. 158 cases of septic patients in intensive care unit （ICU） were enrolled and randomly assigned to three groups according to their different target value of nutrition： group A [ measurements of resting energy expenditure （ MREE ） 〈 90% ], B （MREE 90%- 110% ） and C （MREE 〉 110% ）. The caloric intake, mechanical ventilation duration （MVD）, nosocomial infection rate, 28-day and 60-day mortality were analyzed. Results Daily energy intake in 7 days after ICU admission was as follows ： the difference in target value of nutrition （k J/d： 7 075.0 ± 1 046.5, 5 667.8 ± 1 908.8, 4 428.8 ± 1 377.8）, calory intake （kJ/d： 4 671.6 ± 1 205.6, 5 655.3 ± 1 373.0, 6 053.0 ± 1 557.2）, enteral nutrition value （M/d： 2 051.1 ± 1 046.5, 3 980.9± 1 586.5, 5 337.1 ± 2 921.8） and average intake rate [（66.0 ± 15.8）%, （ 100.0 ±5.7）%, （134.0 ± 19.7）%], and they were statistically significant difference among A, B, C groups （all P〈 0.05 ）. The parenteral nutrition in group C were much higher than that in group A and group B （kJ/d： 2 055.3 ± 273.4 vs. 427.0 ± 273.4, 473.0 ±332.0, both P〈0.05 ）. The calories provided by glucose and diprivan were similar among three groups. The MVD and ICU stay were shorter in group B than that in groups A and C [MVD （days） ： 8.4 ±6.3 vs. 11.0 ± 8.2, 17.8 ± 13.0, P〉0.05 and P〈0.05 ; ICU stay （days） ： 11.0 ± 6.4 vs. 14.9 ± 9.6, 17.8 ± 13.0, respectively, P〉0.05 and P〈0.05）. The total hospital stay （days： 32.0 ± 22.5, 26.8 ± 7.0, 30.4 ± 21.4） and nosocomial infection rate [91.1% （51/56）, 84.0% （42/50）, 90.4% （47/52）] were similar among A, B, C groups （all P〉0.05）. There was no difference in survival rate at 28 days among three groups as shown by the Kaplan-Meier