Dickerson Roland N, Gervasio Jane M, Riley Marti L, Murrell James E, Hickerson William L, Kudsk Kenneth A, Brown Rex O
Department of Clinical Pharmacy, University of Tennessee, Memphis 38163, USA.
JPEN J Parenter Enteral Nutr. 2002 Jan-Feb;26(1):17-29. doi: 10.1177/014860710202600117.
The purpose of this study was to evaluate the bias and precision of 46 methods published from 1953 to 2000 for estimating resting energy expenditure (REE) of thermally injured patients.
Twenty-four adult patients with > or =20% body surface area burn admitted to a burn center who required specialized nutrition support and who had their REE measured via indirect calorimetry (IC) were evaluated. Patients with morbid obesity, human immunovirus, malignancy, pregnancy, hepatic or renal failure, neuromuscular paralysis, or those requiring a FiO2 >50% or positive end expiratory pressure (PEEP) > or =10 cm H2O were excluded. One steady-state measured REE measurement (MEE) was obtained per patient. The methods of Sheiner and Beal were used to assess bias and precision of these methods. The formulas were considered unbiased if the 95% confidence interval (CI) for the error (kilocalories per day) intersected 0 and were considered precise if the 95% CI for the absolute error (%) was within 15% of MEE.
MEE was 2780+/-567 kcal/d or 158%+/-34% of the Harris Benedict equations. None of the methods was precise (< or =15% CI error). Over one-half (57%) of the 46 methods had a 95% confidence interval error >30% of the MEE. Forty-eight percent of the methods were unbiased, 33% were biased toward overpredicting MEE, and 19% consistently underpredicted MEE. The pre-1980s methods more frequently overpredicted MEE compared with the 1990 to 2000 (p < .01) and 1980 to 1989 (p < .05) published methods, respectively. The most precise unbiased methods for estimating MEE were those of Milner (1994) at a mean error of 16% (CI of 10% to 22%), Zawacki (1970) with a mean error of 16% (CI of 9% to 23%), and Xie (1993) at a mean error of 18% (CI of 12% to 24%). The "conventional 1.5 times the Harris Benedict equations" was also unbiased and had a mean error of 19% (CI of 9% to 29%).
Thermally injured patients are variably hypermetabolic and energy expenditure cannot be precisely predicted. If IC is not available, the most precise, unbiased methods were those of Milner (1994), Zawacki (1970), and Xie (1993).
本研究旨在评估1953年至2000年间发表的46种估算热损伤患者静息能量消耗（REE）方法的偏差和精密度。
对24例入住烧伤中心、体表面积烧伤≥20%、需要特殊营养支持且通过间接测热法（IC）测量REE的成年患者进行评估。排除病态肥胖、感染人类免疫病毒、患有恶性肿瘤、妊娠、肝或肾功能衰竭、神经肌肉麻痹的患者，以及那些需要吸入氧分数>50%或呼气末正压（PEEP）≥10 cm H₂O的患者。每位患者获得一次稳态测量的REE测量值（MEE）。采用Sheiner和Beal的方法评估这些方法的偏差和精密度。如果误差（千卡/天）的95%置信区间（CI）与0相交，则认为公式无偏差；如果绝对误差（%）的95%CI在MEE的15%以内，则认为公式精密。
MEE为2780±567 kcal/d，或为哈里斯-本尼迪克特方程的158%±34%。没有一种方法是精密的（CI误差≤±15%）。46种方法中有超过一半（57%）的95%置信区间误差>MEE的30%。48%的方法无偏差，33%倾向于高估MEE，19%持续低估MEE。与1990年至2000年（p<0.01）和1980年至1989年（p<0.05）发表的方法相比，20世纪80年代以前的方法更常高估MEE。估算MEE最精密且无偏差的方法是米尔纳（1994年）的方法，平均误差为16%（CI为10%至22%），扎瓦茨基（1970年）的方法平均误差为16%（CI为9%至23%），以及谢（1993年）的方法平均误差为18%（CI为12%至24%）。“哈里斯-本尼迪克特方程的常规1.5倍”也无偏差，平均误差为19%（CI为9%至29%）。
热损伤患者代谢亢进程度各异，能量消耗无法精确预测。如果无法进行IC测量，最精密且无偏差的方法是米尔纳（1994年）、扎瓦茨基（1970年）和谢（1993年）的方法。
