Nghiên cứu áp dụng kỹ thuật đo nhiệt lượng gián tiếp để xác định nhu cầu năng lượng ở bệnh nhân thở máy xâm nhập

B GIO DC V O TO B Y T TRNG I HC Y H NI ======= V SN TNG NGHIÊN CứU áP DụNG Kỹ THUậT ĐO NHIệT Lợng gián tiếp để xác định NHU CầU lợng bệnh nhân thở máy xâm NHậP LUN VN THC S Y HC H NI 2016 B GIO DC V O TO B Y T TRNG I HC Y H NI ======= V SN TNG NGHIÊN CứU áP DụNG Kỹ THUậT ĐO NHIệT Lợng gián tiếp để xác định NHU CầU lợng bệnh nhân thở máy xâm NHậP Chuyờn ngnh Mó s : Hi sc cp cu : 60.72.01.22 LUN VN THC S Y HC Ngi hng dn khoa hc: TS NGC SN TS Lấ TH DIM TUYT H NI 2016 LI CM N Lun c hon thnh bng s c gng, n lc ca bn thõn cựng vi s giỳp ca nhiu cỏ nhõn v th Nhõn dp hon thnh lun tt nghip, vi lũng kớnh trng v bit n sõu sc, tụi xin by t li cm n ti: - ng y, Ban Giỏm hiu, Phũng o to Sau i hc, B mụn Hi sc Cp cu v cỏc B mụn ca Trng i hc Y H Ni ó to iu kin thun li cho tụi quỏ trỡnh hc tp, nghiờn cu v hon thnh lun - ng y, Ban Giỏm c, Khoa Cp cu, Khoa Húa sinh, Khoa Huyt hc Bnh vin Bch Mai ó to iu kin thun li cho tụi quỏ trỡnh hc tp, nghiờn cu v hon thnh lun - ng y, Ban Giỏm c, Khoa Cp cu bnh vin a khoa tnh Thỏi Bỡnh ó luụn ng viờn, khuyn khớch, giỳp tụi quỏ trỡnh hc v nghiờn cu khoa hc - Tụi xin c th hin lũng bit n ti TS Ngc Sn, TS Lờ Th Dim Tuyt l nhng ngi thõy ó luụn tn tỡnh ch bo, truyn t kin thc v kinh nghim quy bỏu cho tụi quỏ trỡnh hc tp, ng thi trc tip hng dõn tụi hon thnh lun tt nghip - Tụi xin trõn trng cm n PGS TS Nguyn t Anh, Trng B mụn Hi sc Cp cu Trng i hc Y H Ni, Trng khoa Cp cu Bnh vin Bch Mai ó tn tỡnh hng dõn v to mi iu kin thun li cho tụi sut quỏ trỡnh hc v nghiờn cu khoa hc - Tụi cng xin c cm n ton th Cỏn b nhõn viờn Khoa Cp cu, Khoa iu tr tớch cc, Trung tõm chng c bnh vin Bch Mai, ó to mi iu kin thun li, giỳp v ng viờn tụi sut quỏ trỡnh hc v nghiờn cu - Xin trõn trng cm n cỏc Thy, Cụ Hi ng chm lun ó cho tụi nhng y kin úng gúp quy bỏu hon thnh lun ny Cỏc y kin gúp y ca cỏc Thõy, Cụ s l bi hc b ớch cho tụi trờn ng nghiờn cu khoa hc sau ny Xin c by t lũng bit n sõu sc n: - Cỏc bnh nhõn iu tr ti Khoa Cp cu Bnh vin Bch Mai ó cho tụi cú iu kin hc tp, nghiờn cu v hon thnh lun ny - Cỏc bn bố ng nghip v ngi thõn gia ỡnh, nhng ngi ó luụn ng viờn, khớch l tụi sut quỏ trỡnh hc v nghiờn cu H Ni, ngy 10 thỏng 12 nm 2016 V Sn Tựng LI CAM OAN Tụi l Vỳ Sn Tựng, hc viờn cao hc khúa 23 Trng i Hc Y H Ni, chuyờn ngnh Hi Sc Cp Cu, xin cam oan: õy l lun bn thõn tụi trc tip thc hin di hng dõn ca Thõy TS Ngc Sn v TS Lờ Th Dim Tuyt Cụng trỡnh ny khụng trựng lp vi bt k nghiờn cu no khỏc ó c cụng b ti Vit Nam Cỏc s liu v thụng tin nghiờn cu l hon ton chớnh xỏc, trung thc v khỏch quan, ó c xỏc nhn v chp nhn ca Bnh vin Bch Mai Tụi xin hon ton chu trỏch nhim trc phỏp lut v nhng cam kt ny H Ni, ngy 10 thỏng 12 nm 2016 Ngi vit cam oan V Sn Tựng DANH MC CC CH VIT TT AEE APACHE II BEE BMI BMR COPD CVCO2 CVO2 DEE DIT FiO2 HBE HBE x SF IC ICU PEEP PS2003 REE REEm RQ Tiờu hao nng lng hot ng (Activity Energy Expenditure ) Bng im ỏnh giỏ tỡnh trng sc kho v cỏc thụng s sinh ly giai on cp phiờn bn II (Acute Physiology and Chronic Health Evaluation II) Tiờu hao nng lng iu kin c s (Basal Energy Expenditure) Ch s c th (Body Mass Index) Mc chuyn húa c s (Basic Metabolic Rate) t tin trin cp bnh phi mn tớnh tc nghn (Chronic Obtructive Pulmonary Disease) H s bin thiờn th tớch CO2 tiờu th H s bin thiờn th tớch oxy tiờu th Tiờu hao nng lng thc n (Diet Energy Expenditure) Hiu ng nhit ca thc n (Diet Induced Thermogenesis) Nng Oxy khớ th vo Phng trỡnh Harris Benedict (Harris Benedic Equation) Phng trỡnh Harris Benedict thờm h s (yu t stress) Nhit lng giỏn tip ( Indirect Calorimetry) n v hi sc tớch cc (Intensive Care Unit) p lc dng cui thỡ th (Positive End Expiratory Pressure) Phng trỡnh Penn State 2003 Tiờu hao nng lng lỳc ngh (Resting Energy Expenditure) Tiờu hao nng lng lỳc ngh o Thng s hụ hp (Respiratory quotient) SIRS SpO2 TEE VCO2 VO2 WHO Hi chng ỏp ng viờm h thng (Systemic Inflammatory Response Syndrome) bóo hũa oxy mỏu ngoi vi (Saturation of peripheral oxygen) Tiờu hao nng lng tng (Total Energy Expenditure) Th tớch CO2 sn xut Th tớch Oxy tiờu th T chc y t th gii (World Health Organization) MC LC DANH MC BNG DANH MC BIU 97 Nờn tin hnh o nhit lng lng giỏn tip xỏc nh nhu cõu nng lng cho tt c cỏc bnh nhõn nng trng hp cỏc iu kin o c tha Trng hp khụng thc hin o nng lng c hoc khụng cú thit b o thỡ phng trỡnh Penn State 2003 cú th cõn nhc ỏp dng i vi cỏc bnh nhõn nng l n v/hoc cú BMI < 18,5 Mc nng lng 30 kcal/kg cng cú th cõn nhc ỏp dng vi cỏc bnh nhõn nng cú BMI < 18,5 TI LIU THAM KHO Alberda C., Snowden L., McCargar L., et al (2002) Energy requirements in critically ill patients: how close are our estimates? 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