Weissman C, Kemper M, Hyman A I
Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York.
Anesth Analg. 1989 Apr;68(4):457-61.
There has been increasing interest in the nutritional support of the critically ill patient. The day-to-day variation in resting energy expenditure (REE) was studied over a 3-5-day period in 17 postoperative mechanically ventilated critically ill patients to gain insight as to how often caloric intake should be reassessed, whether changes observed over 3-5 days are of sufficient magnitude to make frequent adjustments in caloric intake, and what factors are associated with large alterations in metabolic rate. REE was measured daily for 3-5 days, and the percent variation in REE [(highest REE--lowest daily REE)/(lowest daily REE) x 100] calculated. The variation ranged from 4 to 56%, and on further analysis two distinct groups were identified, one with a mean variation of 12 +/- 4% (SD) (range 4-18%) and the other with a mean variation of 46 +/- 8% (range 37-56%). The former group was clinically stable, whereas the latter was not. Clinically stable patients need less frequent measurements than those who are more ill, but when designing a nutritional regimen for them, at least 20-25% should be added to the REE, 15% to account for day-to-day variation and 5-10% for activity.
对危重症患者的营养支持越来越受到关注。对17例术后机械通气的危重症患者在3 - 5天内研究了静息能量消耗（REE）的每日变化，以了解应多久重新评估一次热量摄入、在3 - 5天内观察到的变化幅度是否足以频繁调整热量摄入，以及哪些因素与代谢率的大幅改变有关。连续3 - 5天每日测量REE，并计算REE的变化百分比[（最高REE - 最低每日REE）/（最低每日REE）×100]。变化范围为4%至56%，进一步分析确定了两个不同的组，一组平均变化为12±4%（标准差）（范围4 - 18%），另一组平均变化为46±8%（范围37 - 56%）。前一组临床稳定，而后一组不稳定。临床稳定的患者比病情较重的患者测量频率更低，但在为他们设计营养方案时，应在REE基础上增加至少20 - 25%，其中15%用于考虑每日变化，5 - 10%用于考虑活动。
