危重症患者中使用菲克法计算的氧耗量与间接测热法测量的氧耗量之间的相关性。

Correlation between oxygen consumption calculated using Fick's method and measured with indirect calorimetry in critically ill patients.

作者信息

Marson Flávio, Auxiliadora Martins Maria, Coletto Francisco Antonio, Campos Antonio Dorival, Basile-Filho Anibal

机构信息

Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.

出版信息

Arq Bras Cardiol. 2004 Jan;82(1):77-81, 72-6. doi: 10.1590/s0066-782x2004000100007. Epub 2004 Feb 12.

DOI:10.1590/s0066-782x2004000100007

PMID:14978596

Abstract

OBJECTIVE

To compare the oxygen consumption index measured by using indirect calorimetry (VO2I Delta) with a portable metabolic cart and calculated according to Fick's principle (VO2 I Fick) in critically ill patients.

METHODS

Fourteen patients (10 men and 4 women, mean age 39.4 +/- 5.4 years) were analyzed, 5 of them trauma victims and 9 sepsis victims. The following mean scores were obtained for these patients: APACHE II = 21.3+/-1.8, ISS = 24.8+/-6, and sepsis score = 19.6+/-2.3. The mortality risk (odds ratio), calculated from APACHE II, was 41.9+/-7.1%. All patients underwent mechanical ventilation and invasive hemodynamic monitoring with a Swan-Ganz catheter. VO2 was obtained using the 2 methods (VO2I Delta and VO2I Fick) at 4 different times (T1-T4).

RESULTS

A good correlation was found between the 2 methods (r=0.77) for the mean of the 4 serial measurements. No statistically significant differences were observed between indirect calorimetry and Fick's equation at T1 (VO2I Delta = 138+/-28 and VO2I Fick = 59+/-38 mL.min-2.m-2, P=0.10) and T3 (VO2I Delta = 144+/-26 and VO2I Fick = 158+/-35 mL.min-2.m-2, P=0.14), but a significant difference was observed at T2 (VO2I Delta = 141+/-27 and VO2I Fick = 155+/-26 mL.min-2.m-2, P=0.03) and T4 (VO2I Delta = 145+/-24 and VO2I Fick = 162+/-26 mL.min-2.m-2, P=0.01).

CONCLUSION

We may state that indirect calorimetry can be used for oxygen consumption analysis in critically ill patients and is as efficient as Fick's reverse equation, with the benefit of being a noninvasive and risk-free procedure.

摘要

目的

比较使用便携式代谢车通过间接测热法测得的氧耗指数（VO2I Delta）与根据菲克原理计算得出的氧耗指数（VO2I Fick）在危重症患者中的情况。

方法

分析了14例患者（10例男性和4例女性，平均年龄39.4±5.4岁），其中5例为创伤患者，9例为脓毒症患者。这些患者获得了以下平均评分：急性生理与慢性健康状况评分系统II（APACHE II）=21.3±1.8，损伤严重度评分（ISS）=24.8±6，脓毒症评分=19.6±2.3。根据APACHE II计算的死亡风险（比值比）为41.9±7.1%。所有患者均接受机械通气，并使用Swan-Ganz导管进行有创血流动力学监测。在4个不同时间点（T1-T4）使用两种方法（VO2I Delta和VO2I Fick）获取VO2。

结果

4次连续测量的平均值在两种方法之间发现有良好的相关性（r=0.77）。在T1（VO2I Delta =138±28且VO II Fick =59±38 mL·min⁻²·m⁻²）和T3（VO2I Delta =144±26且VO2I Fick =158±35 mL·min⁻²·m⁻²）时，间接测热法与菲克方程之间未观察到统计学上的显著差异（P=0.10和P=0.14），但在T2（VO2I Delta =141±27且VO2I Fick =155±26 mL·min⁻²·m⁻²）和T4（VO2I Delta =145±24且VO2I Fick =162±26 mL·min⁻²·m⁻²）时观察到显著差异（P=0.03和P=0.01）。