外科机械通气重症患者静息能量代谢评估

Measurements of resting energy expenditure in surgical critically ill patients with mechanical ventilator

目的比较间接能量测定法测定的机械通气条件下外科重症患者静息能量代谢值与Harris—Benedict公式法和体重法计算值的差异，探讨外科重症患者静息能量代谢评估方法。方法以2014年4月-2015年4月在首都医科大学宣武医院外科重症监护室接受机械通气的29例重症患者为研究对象，共纳入患者29例，其中男性13例，女性16例，测量静息能量代谢值188例次。采用间接能量测定法测定机械通气后第1、3、5天的静息能量代谢值，与根据身高、体重采用Harris-Benedict公式法和体重法所计算的静息能量代谢值比较，采用配对样本t检验方法分析重症患者代谢水平分布规律，探讨不同方法计算的静息能量代谢值之间的差异性。结果根据Harris—Benedict公式法计算标准分析患者代谢水平分布规律：低代谢状态117次（62．24％），正常状态59次（31．38％），高代谢状态12次（6．38％）。其中18例患者采用3种方法测得的第1、3、5天静息能量代谢值：间接能量测定法为（1627．11±323．63）kcal、（1614．674-308．93）kcal、（1576．11±263．96）kcal；体重法为（1479．44±200．24）kcal、（1488．40±227．72）kcal、（1434．14±216．56）kcal；Harris—Benedict公式法为（1777．43±253．00）kcal、（1730．08±265．18）kcal、（1689．33±236．69）kcal。分析得出通过Harris—Benedict公式法和体重法测得的静息能量代谢值与通过间接能量测定法测得值均存在显著差异，Harris—Benedict公式法显著高于间接能量测定法（均P〈0．05），体重法显著低于间接能量测定法（均P〈0．05）。结论虽然Harris—Benedict公式法和体重法临床上使用简便易行，但与间接能量测定法测定结果仍有较大差距。临床应尽量按照间接能量测定法测得的静息能量代谢值提供营养支持。

Objective To compare the differences between measured resting energy expenditure calculated by the indirect calorimetry with the resting energy expenditure calculated by the HanSs-Benedict formula and weight formula in the mechanically ventilated surgical critically ill patients in SICU. Methods Patients mechanically ventilated in SICU of Xuanwu Hospital, from April 2014 to April 2015 were measured resting energy expenditure by the indirect calorimetry with the resting energy expenditure calculated by the Harris-Benedict formula and weight formula in the 1st, the 3rd and the 5th day. There were twenty-nine patients enrolled, thirteen males and sixteen females, measured the resting energy expenditure 188 times. The distribution of metabolism level was studied, and the resting energy expenditure measured by three methods were calculated and evaluated by paired sample t test. Results There were 177 times （62.24%） of low metabolism level, 59 times（ 31.38% ） of normal metabolism level, and 12 times（6.38% ）of high metabolism level. Eighteen patients used these three methods to calculate the energy expenditure on 1st, 3rd and 5th day： indirect calorimetry （ 1 627.11 ±323.63） kcal, （ 1 614.67 ±308.93） kcal, （ 1 576.11 ± 263.96） kcal ; Weight formula （ 1 479.44 ± 200.24） kcal, （ 1 488.40 ± 227.72） kcal, （ 1434.14 ± 216.56） kcal; Harris-Benedict formula （ 1 777.43±253.00） kcal, （ 1 730.08 ± 265.18） kcal, （ 1 689.33 ± 236.69 ） keal. The results calculated from Harris-Benedict formula and the weight formula were significantly different from calculated from indirect calorimetry （ P 〈 0.05 ）. Resting energy expenditure by Harris- Benedict formula was significantly higher than calculated from indirect calorimetry （All P 〈 0. 05 ）. Resting energy expenditure by weight formula was significantly lower than calculated from indirect calorimeti3（ All P 〈 0.05 ）.Conclusions Although Harris-Benedict formula and weight formula is convenient in clinical use, while the results calculated by them is significant different from the results calculated by indirect calorimetry. So clinical nutrition support should rely on indirect calorimetry as far as possible.