Jeevanandam M, Young D H, Schiller W R
Trauma Center, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013.
Crit Care Med. 1990 May;18(5):467-73. doi: 10.1097/00003246-199005000-00001.
Optimal nutritional support should use a patient's energy expenditure as a guide for administering sufficient but not excessive caloric intake. Eight patients requiring parenteral nutrition were evaluated, using indirect calorimetry measurements, to determine the nutritional influence on the rates of substrate utilization in the critical period of catabolic illness due to accidental trauma. Five days of total parenteral nutrition, providing calories to match the measured basal resting energy expenditure and N to replace the initial urinary losses a) shifted the RQ from 0.74 +/- 0.03 to 0.81 +/- 0.03, b) improved but could not reverse negative N balance, c) decreased net fat oxidation, d) increased carbohydrate and protein oxidation, e) elevated daily norepinephrine and epinephrine excretion rates, and f) attained positive energy balance. The results suggest that positive energy balance could be achieved in trauma patients by providing total energy intake matching their basal measured energy expenditure plus 7% to 10% for activity energy expenditure. To prevent further loss of lean body mass, an N intake of 350 mg/kg.day was needed in these catabolic ICU patients.
最佳营养支持应以患者的能量消耗为指导，给予充足但不过量的热量摄入。对8例需要肠外营养的患者进行了评估，采用间接测热法测量，以确定在因意外创伤导致的分解代谢疾病的关键时期，营养对底物利用速率的影响。进行了5天的全肠外营养，提供的热量与测得的基础静息能量消耗相匹配，氮的摄入量以弥补最初的尿氮损失，结果如下：a）呼吸商从0.74±0.03变为0.81±0.03；b）改善了但未能扭转负氮平衡；c）净脂肪氧化减少；d）碳水化合物和蛋白质氧化增加；e）每日去甲肾上腺素和肾上腺素排泄率升高；f）实现了正能量平衡。结果表明，通过提供与基础测得能量消耗相匹配的总能量摄入，并额外增加7%至10%的活动能量消耗，创伤患者可以实现正能量平衡。为防止瘦体重进一步流失，这些处于分解代谢状态的重症监护病房患者每天需要摄入350mg/kg的氮。
