[重症监护病房患者间接测热法与传统能量消耗估计法测量能量消耗的比较]

[Comparison of measuring energy expenditure with indirect calorimetry and traditional estimation of energy expenditure in patients in intensive care unit].

作者信息

Xiao Gui-zhen, Su Lei, Duan Peng-kai, Wang Qin-xian, Huang Ying

机构信息

Nutrition Department, Guangzhou General Hospital of Guangzhou Military Command, PLA, Guangzhou 510010, Guangdong, China.

出版信息

Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2011 Jul;23(7):392-5.

PMID:21787465

Abstract

OBJECTIVE

To compare measurement of energy expenditure (MEE) by indirect calorimetry (IC) with traditional estimation of energy expenditure (EEE), to provide a basis for energy supplementary for critically ill patients.

METHODS

Using self-controlled study,the energy expenditure of 57 intensive care unit (ICU) patients was measured by IC. Meanwhile, EEE was also calculated using the following equations : Harris-Benedict (HB), HB×factor , or 104.6 kJ/kg. Body weight were calculated using actual body weight (ABW) or ideal body weight (IBW). If body mass index (BMI)<18.4 kg/m(2) it was considered as underweight , and the IBW was selected from the IBW table. The potential adequacy of estimated energy was assayed by ratio of EEE/MEE.

RESULTS

There was significant difference in MEE by IC and EEE by HB, HB×factor and 104.6 kJ/kg [(6 335 ± 1 004) kJ, (9 125 ± 1 795) kJ, (7 188 ± 1 029) kJ vs. (7 753 ± 1 439) kJ ,P<0.05 or P<0.01]. There was significant difference between EEE by HB×factor and 104.6 kJ/kg (P<0.01) , and EEE by 104.6 kJ/kg×ABW , and the latter was closer to MEE. Underfeeding would occur in most ICU patients if HB equation was used [100% (4/4) in underweight patients and 73.59% (39/53) in normal weight (BMI 18.5-23.9 kg/m(2))]. EEE as calculated by 104.6 kJ/kg×IBW was reasonable in the underweight patients 100% ( 4/4 ), but EEE in the patients with normal weight by using HB×factor or 104.6 kJ/kg×ABW resulted in significant underfeeding [39.62% (21/53) and 43.39% (23/53)] or overfeeding [24.53% (13/53) and 13.22% (7/53)].

CONCLUSION

EEE derived from the equations was extremely inaccurate and may result in significant underfeeding or overfeeding in individuals. On the basis of this study we would recommend IC for measuring energy expenditure in ICU patients. Otherwise , the equations of 104.6 kJ/kg×IBW in underweight and 104.6 kJ/kg×ABW in normal weight patients may be reasonable.

摘要

目的

比较间接测热法（IC）测量的能量消耗（MEE）与传统能量消耗估计值（EEE），为危重症患者的能量补充提供依据。

方法

采用自身对照研究，用IC测量57例重症监护病房（ICU）患者的能量消耗。同时，也使用以下公式计算EEE：哈里斯-本尼迪克特（HB）公式、HB×系数或104.6 kJ/kg。体重采用实际体重（ABW）或理想体重（IBW）计算。如果体重指数（BMI）<18.4 kg/m²，则视为体重过轻，从IBW表中选取IBW。通过EEE/MEE的比值来分析估计能量的潜在充足性。

结果

IC测量的MEE与HB公式、HB×系数和104.6 kJ/kg计算的EEE之间存在显著差异[（6335±1004）kJ、（9125±1795）kJ、（7188±1029）kJ对（7753±1439）kJ，P<0.05或P<0.01]。HB×系数和104.6 kJ/kg计算的EEE之间存在显著差异（P<0.01），104.6 kJ/kg×ABW计算的EEE与MEE更接近。如果使用HB公式，大多数ICU患者会出现能量摄入不足[体重过轻患者中为100%（4/4），正常体重（BMI 18.5-23.9 kg/m²）患者中为73.59%（39/53）]。104.6 kJ/kg×IBW计算的EEE在体重过轻患者中100%（4/4）是合理的，但正常体重患者使用HB×系数或104.6 kJ/kg×ABW计算的EEE会导致显著的能量摄入不足[39.62%（21/53）和43.39%（23/53）]或能量摄入过多[24.53%（13/53）和13.22%（7/53）]。