代谢车与Harris-Benedict公式在慢性阻塞性肺疾病患者营养支持的对比研究

The contrast study of nutritional support of critical care management system and Harris-Benedict formula in patients with chronic obstructive pulmonary disease

目的:比较代谢车(CCM)监测静息能量消耗(REE)与Harris-Benedict(HB)公式计算的基础能量消耗(BEE)在慢性阻塞性肺疾病(COPD)患者营养支持治疗中的应用价值。方法:选择诊断符合中华医学会呼吸病学分会制定的COPD诊治指南及微型营养评定法(MNA)评定为营养不良的57例COPD住院患者。将研究对象随机分为两组,分别按代谢车监测的静息能量消耗及HB公式计算的基础能量消耗计算每日能量需求后进行营养支持治疗,于第1天、第10天测定COPD患者吸气开始0.1 s时口腔阻断压(P0.1)、口腔最大吸气压(Pimax)、口腔最大呼气压(Pemax)、1 s用力呼气容积(FEV1)占预计值百分比(FEV1%)、最大通气量(MVV)占预计值百分比(MVV%)、动脉血二氧化碳分压(PaCO2)、血清白蛋白(Alb)、血清转铁蛋白(TF)、血清前白蛋白(PAlb)。结果:依据HB公式计算的每日能量需求与代谢车测量的每日能量需求比较,HB公式组较代谢车组高出约13.6%,差异有统计学意义(P<0.05);两组常规并营养支持治疗后P0.1、PaCO2值均下降,Pimax、Pemax、Alb、TF、PAlb值均增高(P<0.05),而FEV1%、MVV%无明显变化(P>0.05);代谢车组比HB公式组血清前白蛋白(PAlb)增加明显(P<0.05),其余各指标差异均无统计学意义(P>0.05)。结论:按代谢车监测的静息能量消耗计算的每日能量需求更接近患者的实际能量消耗,但代谢车与HB公式两种方法在COPD患者中营养支持效果无明显区别。

Objective： To compare the nutritional support value of resting energy expenditure （REE） measured with Critical Care Management system （CCM） with that of basal energy expenditure （BEE） measured with Harris-Benedict formula in patients with chronic obstructive pulmonary disease （COPD）. Methods： The 57 patients with malnutritional COPD who were diagnosised by the guideline of COPD made by the respiratory branch of Chinese Medical Association and mini nutritional assessment （MNA） were devided into two groups, who were treated with nutritional support by resting energy expenditure （REE） measured with CCM and basal energy expenditure （BEE） measured with Harris-Benedict formula. The parameters with regard to inspiratory pressure after 0. 1 sec. at tidal breathing （P0.1）, maximal mouth inspiratory pressure （Pimax）, maximal mouth expiratory pressure （Pemax）, percent of forced expiratory volume in 1 second （FEV1%）, percent of maximal voluntary ventilation （MVV%）, arterial carbon dioxide tension （PaCO2）, serum albumin （Alb）, serum transferrin （TRF） and prealbumin （PAlb） were measured in all patients at the first day of admission and the tenth day after nutritional support. Results： HBBEE were higher than the REE measured with CCM system by about 13. 6% （P 〈0. 05）. There was significant difference. Compared to two groups after nutritional support and common therapy, the values of P0.1 and PaCO2 were obviously decreased, the values of Pimax, Pemax, Alb, TRF and PAlb were obviously increased （P 0.05）, FEV1% and MVV had no change obviously （P 〉0.05）, the values of PAlb of CCM were increased obviously than that of Harris-Benedict formula （P 〈0.05）. There was no obviously difference in others parameters （P〉0.05）. Conclusion： REE measured dynamically with CCM is more accurate. But the effect of nutritional support was no significant difference between the method of CCM and HB.