Touho H, Karasawa J, Shishido H, Morisako T, Yamada K, Shibamoto K
Department of Neurosurgery, Osaka Neurological Institute, Japan.
J Neurosurg. 1990 May;72(5):710-4. doi: 10.3171/jns.1990.72.5.0710.
Oxygen consumption (VO2), carbon dioxide production (VCO2), urinary nitrogen excretion, respiratory quotient, resting energy expenditure (REE), %REE, and the consumption rates of carbohydrate, fat, and protein (%CHO, %Fat, %Prot, respectively) were determined pre- and postoperatively by indirect calorimetry in 13 patients with ruptured intracranial aneurysms and 11 patients with hypertensive intracerebral hemorrhage in the acute stage. The preoperative VCO2, VO2, urinary nitrogen excretion, respiratory quotient, REE, and %REE were, respectively (mean +/- standard deviation): 171 +/- 46 ml/min, 203 +/- 56 ml/min, 10.3 +/- 1.7 gm/day, 0.84 +/- 0.01, 1397 +/- 389 Cal/day, and 129% +/- 8%. The values for VCO2, VO2, REE, and %REE were all increased above normal levels. The %Prot was increased to 26.1% +/- 9.1%. In the postoperative period, the VCO2, VO2, urinary nitrogen excretion, REE, and %REE significantly increased to: 186 +/- 44 ml/min, 229 +/- 56 ml/min, 14.8 +/- 2.9 gm/day, 1557 +/- 384 Cal/day, and 141% +/- 21%, respectively. The %Fat and %Prot also increased significantly, but the %CHO significantly decreased. Preoperatively, in the patients with ruptured intracranial aneurysms, there was a greater increase in %Prot in eight patients classified (according to Fischer) as having a Group 3 or 4 subarachnoid hemorrhage (SAH) on computerized tomography than in five patients classified as having a Group 1 or 2 SAH. In summary, increased metabolic expenditure, especially increased catabolism of protein and fat, is characteristic of accompanying hemorrhagic cerebrovascular disease, and there is an increase in consumption of fat and protein in the postoperative period. Lack of precise knowledge about the cause and consequences of these metabolic responses makes it impossible at present to judge the optimal extent of nutritional replacement. The hypermetabolic state should be taken into consideration when caring for these patients as it may cause weight loss, poor wound healing, and susceptibility to infection.
通过间接测热法，对13例颅内动脉瘤破裂患者和11例急性期高血压脑出血患者在术前和术后测定了氧耗量（VO₂）、二氧化碳产生量（VCO₂）、尿氮排泄量、呼吸商、静息能量消耗（REE）、REE百分比，以及碳水化合物、脂肪和蛋白质的消耗率（分别为%CHO、%Fat、%Prot）。术前VCO₂、VO₂、尿氮排泄量、呼吸商、REE和REE百分比分别为（均值±标准差）：171±46 ml/分钟、203±56 ml/分钟、10.3±1.7克/天、0.84±0.01、1397±389卡/天和129%±8%。VCO₂、VO₂、REE和REE百分比的值均高于正常水平。%Prot增加至26.1%±9.1%。术后，VCO₂、VO₂、尿氮排泄量、REE和REE百分比显著增加至：分别为186±44 ml/分钟、229±56 ml/分钟、14.8±2.9克/天、1557±384卡/天和141%±21%。%Fat和%Prot也显著增加，但%CHO显著下降。术前，在计算机断层扫描中被分类（根据菲舍尔分类法）为3级或4级蛛网膜下腔出血（SAH）的8例颅内动脉瘤破裂患者中，%Prot的增加幅度大于被分类为1级或2级SAH的5例患者。总之，代谢消耗增加，尤其是蛋白质和脂肪分解代谢增加，是伴随出血性脑血管疾病的特征，并且术后脂肪和蛋白质的消耗增加。目前，由于对这些代谢反应的原因和后果缺乏精确了解，无法判断营养补充的最佳程度。在护理这些患者时应考虑到高代谢状态，因为它可能导致体重减轻、伤口愈合不良和易感染。
