기계환기 중인 중환자에서 영양생화학적 지표 측정의 의의
Clinical value of the biochemical and nutritional parameters of intensive-care unit patients on mechanical ventilation
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목적 : 중증의 환자에게 있어 생화학적 영양 상태는 질병에서 회복되는 데에 매우 중요하다. 따라서 본 연구에서는 기계 환기 중인 중환자에서의 영양생화학적 지표를 측정하고자 한다. 방법 : 중환자실에 입원하여 기계 환기 중인 중환자 126명(남자 72명, 여자 54명)을 대상으로 하여 영양생화학적 지표로써 혈청 총단백, 알부민, 헤모글로빈, 헤마토크릿, 칼슘, 무기인, %임파구(%Lymphocyte), 혈액요소질소 및 크레아티닌을 조사하였다. 예후인자로 기계 환기 기간, 중환자실 입원기간 및 총 입원기간을 후향적으로 조사하여 예후인자와 영양생화학적 지표와의 상관관계를 분석하였다. 결과 : 헤모글로빈은 예후인자인 중환자실 입원기간(p<0.05), 총 입원기간(p<0.01), 그리고 기계 환기 기간(p<0.01)과 음의 상관관계를 보였다. 크레아티닌은 중환자실 입원기간(p<0.01), 총 입원기간(p<0.01), 그리고 기계 환기 기간(p<0.05)과 양의 상관관계를 보였다. 예후인자에 따른 다중회귀분석에서 중환자실 입원기간에 영향을 미치는 독립된 인자는 혈액요소질소와 크레아티닌이었고, 총 입원기간에 영향을 미치는 독립된 인자는 혈액요소질소이었으며, 기계 환기 치료기간에 영향을 미치는 독립된 인자는 혈청 총단백, 알부민, 칼슘, 무기인, 혈액요소질소 및 크레아티닌이었다. 결론 : 이러한 결과로 미루어 볼 때 기계 환기 중인 중환자에게는 영양 불량과 빈혈의 위험성이 있으며, 이에 영양 불량과 빈혈의 발생을 줄일 수 있는 적절한 영양 중재가 필요하다.
Abstract
Background : The nutritional status of critical-ill patients is important for recovering from the disease itself. Therefore, this present study was designed to assess the biochemical and nutritional parameters of Intensive-Care Unit (ICU) patients on mechanical ventilation. Methods : We retrospectively reviewed the medicial records of 126 patients (male/female=72/54) who were on mechanical ventilationin the ICU. The nutritional parameters such as serum total protein, albumin, hemoglobin, hematocrit, calcium, phosphorus, total cholesterol, % lymphocytes, blood urea nitrogen (BUN), and creatinine (Cr) were measured at the beginning of mechanical ventilation. We also measured the outcome variables such as the duration of mechanical ventilation, the ICU length of stay and the hospitalization period. We analyzed the relationship between the nutritional parameters and the outcome variables of ICU patients on mechanical ventilation. Results : The level of hemoglobin was negatively correlated with the outcome variables; the ICU length of stay (p<0.05), the hospitalized period (p<0.01), and the duration of mechanical ventilation (p<0.01). The creatinine level was positively correlated with the outcome variables; the ICU length of stay (p<0.01), the hospitalized period (p<0.01) and the duration of mechanical ventilation (p<0.05). On the multiple regression analysis, the serum total protein, albumin, calcium, inorganic phosphorus, BUN and creatinine were independent factors affecting the duration of mechanical ventilation. Conclusions : These findings indicate that ICU patients with mechanical ventilation have a risk for malnutrition and anemia. So, an adequate nutritional intervention is required for these patients in order to decrease the prevalence of malnutrition and anemia.(Korean J Med 73:151-158, 2007)
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