严重创伤伤员能量消耗测定

Measurement of energy expenditure in severely injured patients

旨在探讨创伤伤员的能量消耗规律 ,为其营养代谢支持提供依据。测定 18例严重创伤伤员伤后 1～ 10 d的 REE、底物氧化率和氮平衡 ,结果伤后第 1天 REE为 7874 .2 88± 10 2 5.0 8k J/ d( 1882± 2 4 5kcal/ d) ,为 HBBEE的 1.19倍。随时间延长逐渐降低 ,第 10天恢复至正常水平。单脏器伤组 REE下降速度快 ,APACHE II≥ 12组的 REE高于 APACHE II<12组。伤后底物氧化以脂肪为主。严重创伤伤员高代谢水平低于以往的经验值 ,伤前代谢水平和创伤对机体解剖和生理的打击 。

In order to observe the pattern of energy expenditure in trauma patients,the REE, substrate oxygenization and nitrogen balance were measured in1 8severely injured patients. REE in posttrauma day1 was1 882± 2 45 kcal/d,1 .1 9of HBBEE,reduced gradually to normal range on posttrauma day 1 0 .REE in single trauma patients decreased more rapidly than that in multiple trauma patients.REE in patients with APACHE ≥ 1 2 was higher than that in patients with APACHE <1 2 .Fat was the main substrate in posttrauma energy supply.In conclusion,The level of posttrauma hypermetabolism is lower than previously presumed.Basic metabolic level and the anatomic and physiological insults by trauma are main factors determining the REE of trauma patients.