前白蛋白在评价重症患者营养和预后中的作用

目的评价血清前白蛋白水平作为重症患者营养支持效果和预后指标的价值。方法回顾性分析2003年11月～2007年1月在ICU内接受TPN超过7天的35例患者。前白蛋白水平在治疗开始和第7天时分别记录。依据前白蛋白升高还是降低分为两组：组1（n=26）和组2（n=9）。对两组患者的年龄、APACHEⅡ评分、营养状态、营养需要量、补充量、死亡率、住院天数及住ICU天数分别进行比较。结果组1补充能量1874KcaYd（能量需要的91％），组2补充能量1770Kcal／d（能量需要的88％），P=0．121。两组死亡率分别是31％和44％（P=0．762）。平均住院天数／ICU天数分别是73陀2d和61／19d。结论对危重患者而言，前白蛋白水平不是营养支持的敏感指标，其升高并不是预后良好的指标。

The value of prealbumin in nutrition and prognosis of critical ill patients

Objective To evaluate serum prealbumin level as an indicator of the effective of the nutrition support and the prognosis in critical ill patients. Methods Thirty-five patients who received total parenteral nutrition for more than 7 days at an intensive care unit （ICU） from Nov 2003 to Jan 2007 were studied. The serum prealbumin was measured at initial of nutrition support and at the almost seventh day since the first measurement. The patients were allocated into two groups. In group 1（n=26） and 2（n=9）, the prealbumin level increased and decreased ,respectively.Age,APACHE score,nutrition status, nutritional requirement and amount of supply,mortality,hospital day and ICU day in two groups were compared. Results The average calorie intake was 1874Kcal/day （91% of energy requirement） in group 1 and 1770 Kcal/day （88% of the energy requirement） in group 2（P=0.121）.The mortality was 31% in group 1 and 44% in group 2 （P=0.762）.The average hospital day/ICU day in group 1 and group 2 were 73days/22days and 61days/ 19days repectively. Conclusion In critical ill patients, the serum prealbumin level did not reposed sensitively to nutritional support. An increase in the prealbumin level does not indicate a better prognosis for critical ill patients.