McClave S A, McClain C J, Snider H L
University of Louisville School of Medicine, Department of Medicine, Division of Gastroenterology/Hepatology, 550 South Jackson Street, Louisville, KY 40202, U.S.A.
J Clin Gastroenterol. 2001 Jul;33(1):14-9. doi: 10.1097/00004836-200107000-00005.
The use of indirect calorimetry in the design of nutritional support regimens is poorly appreciated by clinicians, who fail to recognize the importance of providing a sufficient volume of enteral feeding to critically ill patients. In contrast to the overfeeding that routinely occurred in the past with the provision of total parenteral nutrition, patients placed on the enteral route of support tend to be underfed because of problems with intolerance and frequent cessation. Clearly identifying and coming as close as possible to the caloric goal may be required to achieve the therapeutic endpoints of enteral tube feeding (which include maintenance of gut integrity, attenuation of the stress response, prophylaxis against stress-induced gastropathy, and stimulation of immune function). Indirect calorimetry is a convenient, accessible, and highly accurate instrument for the measurement of caloric requirements and is a valuable tool for the optimization of nutritional support in the intensive care unit.
临床医生对间接测热法在营养支持方案设计中的应用认识不足，他们没有意识到为重症患者提供足够量肠内营养的重要性。与过去常规提供全胃肠外营养时经常出现的过度喂养相反，接受肠内营养支持途径的患者往往因不耐受问题和频繁中断喂养而摄入不足。要实现肠内管饲的治疗终点（包括维持肠道完整性、减轻应激反应、预防应激性胃黏膜病变以及刺激免疫功能），可能需要明确识别并尽可能接近热量目标。间接测热法是一种方便、易用且高度准确的测量热量需求的仪器，是重症监护病房优化营养支持的宝贵工具。
