重症烧伤患者能量消耗与需求平衡：值得深入研究的问题

Evaluation of the balance between energy supplement and consumption in patients with serious burn： a problem worth further investigation

经过近半个世纪的研究和探索，我国烧伤临床营养取得了长足进步，初步阐明了烧伤代谢规律，基本形成了较完善的营养治疗模式，一般烧伤患者能获得较满意的效果，但重症烧伤患者的疗效还不甚理想。重症烧伤患者一方面呈现持续的高分解状态，机体消耗增加，急需补给；同时又存在营养物质利用障碍，常规营养治疗难以逆转顽固的高分解代谢，其结果为机体自身消耗、自噬代谢等病理表现依旧。

The energy expenditure of burn patients can be determined aecurately by indireet calorimetry measurement, or estimated approximately with energy expenditure equations. However, the energy requirement is not entirely equal to energy expenditure in the whole proeess of burn injury. The energy con- sumption induced by hypereatabolism is increased significantly, and on the other hand, the ability of nutrient absorption and a- nabnlism decreased remarkably in the early phase of burn injury, thus leading to imbalance between energy consumption and de- mand. However, energy supplement as calculated according to energy consumption may induce overfeeding in the early phase of burn injury. Excessive nutrients intake can not be fully utilized to decrease hypermetabnlic reaction, but it might exacerbate metabolic disorder. Therefnre, the energy supplement should be lower than energy consumption during the early stage of burns. With the advanee of disease eourse, the internal environment be- comes stable gradually, ending in a balance between anabolism and catabolism. Energy supplement should be increased gradual- ly according to energy consumption. During the eonvaleseent pe- rind, anabolic metabolism exceeds catabolic metabnlism, there- fore the quantity of energy supplement shouht be moderately higher than that of energy consumption. Thus, the energy con- sumption and energy supplement may reach a balance during the whole eourse of treatment. The purpose of the article is to ana- lyze and discuss how to estimate energy expenditure precisely and evaluate energy requirement cnrreetly, in order to reaeh a balance between energy eonsumption and supplement during a long course of treatment for severe burn patients.