Turi R A, Petros A J, Eaton S, Fasoli L, Powis M, Basu R, Spitz L, Pierro A
Department of Paediatric Surgery, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, London, United Kingdom.
Ann Surg. 2001 Apr;233(4):581-7. doi: 10.1097/00000658-200104000-00015.
To evaluate whether critically ill children with systemic inflammatory response syndrome (SIRS) or sepsis have altered resting energy expenditure (REE) and substrate utilization.
Studies in adults with sepsis have shown increased energy expenditure and mobilization of endogenous fat. In infants and children, energy metabolism and substrate utilization during sepsis have not been characterized.
Metabolic studies were performed in 21 critically ill children with SIRS or sepsis. Twenty-one stable control children, matched for weight, were also studied. Seven patients required inotropic support and 17 received mechanical ventilation. Fifteen patients with SIRS had evidence of bacterial, fungal, or viral infection and were considered septic. Respiratory gas exchange was measured by computerized indirect calorimetry for 1 to 2 hours continuously.
The REE of patients with SIRS or sepsis was not different from that of controls. Similarly, there were no differences in carbon dioxide production and oxygen consumption. Resting energy metabolism was not different between patients with SIRS and patients with sepsis. In addition, the presence of low platelet count or inotropic support did not affect resting energy metabolism. The median respiratory quotient of patients with SIRS or sepsis was 0.88 (range 0.75-1.12), indicating mixed utilization of fat and carbohydrate; this was not significantly different from that of controls. The Pediatric Risk of Mortality Score was not significantly correlated with REE or respiratory quotient.
The energy requirements of children with SIRS or sepsis are not increased. Their resting metabolism is based on both carbohydrate and fat utilization. The authors speculate that these children divert the energy for growth into recovery processes.
评估患有全身炎症反应综合征（SIRS）或脓毒症的危重症儿童静息能量消耗（REE）及底物利用情况是否发生改变。
针对成年脓毒症患者的研究显示能量消耗增加以及内源性脂肪动员。在婴儿和儿童中，脓毒症期间的能量代谢及底物利用情况尚未明确。
对21名患有SIRS或脓毒症的危重症儿童进行了代谢研究。还对21名体重匹配的健康对照儿童进行了研究。7名患者需要使用血管活性药物支持，17名接受了机械通气。15名患有SIRS的患者有细菌、真菌或病毒感染证据，被视为脓毒症患者。通过计算机化间接测热法连续1至2小时测量呼吸气体交换。
患有SIRS或脓毒症的患者的REE与对照组无差异。同样，二氧化碳产生量和氧气消耗量也无差异。SIRS患者和脓毒症患者的静息能量代谢无差异。此外，血小板计数低或使用血管活性药物支持并不影响静息能量代谢。患有SIRS或脓毒症的患者的呼吸商中位数为0.88（范围0.75 - 1.12），表明脂肪和碳水化合物混合利用；这与对照组无显著差异。儿科死亡风险评分与REE或呼吸商无显著相关性。
患有SIRS或脓毒症的儿童的能量需求并未增加。他们的静息代谢基于碳水化合物和脂肪的利用。作者推测这些儿童将用于生长的能量转而用于恢复过程。
