Goldstein S A, Thomashow B M, Kvetan V, Askanazi J, Kinney J M, Elwyn D H
Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, NY 10467.
Am Rev Respir Dis. 1988 Sep;138(3):636-44. doi: 10.1164/ajrccm/138.3.636.
The purpose of this study was to examine the impact of nutritional support on nitrogen-energy relationships and functional parameters in malnourished patients with emphysema. Malnourished patients without lung disease served as the control group. Ten ambulatory, stable patients with emphysema and six patients without lung disease received an infusion of 5% dextrose (baseline) plus electrolytes (D5W) for two days, which was followed by an enteral or a parenteral infusion of either a carbohydrate-based (CB, 53% carbohydrate) or a fat-based diet (FB, 55% fat) for 1 wk each, in a randomized cross-over design. All patients had greater than 10% weight loss. Caloric intake was set at 1.7 times the resting energy expenditure (REE) as measured during the baseline period. The REE of patients with emphysema was 23 and 27% above that of the control group during baseline and refeeding periods, respectively. The increased REE was met primarily by an increased carbohydrate oxidation. During the infusion of D5W, N balance was lower in patients with emphysema, but during repletion N balance was similar in both groups of patients. Two weeks of nutritional support with either a CB or a FB diet increased body weight, N balance, and arm muscle area and improved maximal inspiratory pressure, skeletal muscle strength, and endurance-strength (using quadriceps, hamstring, and handgrip) to a similar degree in malnourished patients with and without lung disease. In other stress states, such as infection, it has been shown that hypermetabolism, hypercatabolism, and preferential fat oxidation occur concomitantly. Patients with emphysema are unusual because, although they are hypermetabolic, they are not hypercatabolic and do not demonstrate preferential fat oxidation.
本研究的目的是探讨营养支持对营养不良的肺气肿患者氮-能量关系及功能参数的影响。无肺部疾病的营养不良患者作为对照组。10例门诊稳定期肺气肿患者和6例无肺部疾病患者接受为期两天的5%葡萄糖（基线）加电解质（D5W）输注，随后采用随机交叉设计，分别接受为期1周的基于碳水化合物的饮食（CB，53%碳水化合物）或基于脂肪的饮食（FB，55%脂肪）的肠内或肠外输注。所有患者体重减轻均超过10%。热量摄入设定为基线期测得的静息能量消耗（REE）的1.7倍。肺气肿患者在基线期和再喂养期的REE分别比对照组高23%和27%。REE的增加主要通过碳水化合物氧化增加来满足。在输注D5W期间，肺气肿患者的氮平衡较低，但在补充期两组患者的氮平衡相似。在有和无肺部疾病的营养不良患者中，采用CB或FB饮食进行两周的营养支持均可使体重、氮平衡和上臂肌肉面积增加，并使最大吸气压力、骨骼肌力量和耐力力量（使用股四头肌、腘绳肌和握力）得到类似程度的改善。在其他应激状态下，如感染，已表明会同时出现高代谢、高分解代谢和优先脂肪氧化。肺气肿患者则不同，尽管他们处于高代谢状态，但并不处于高分解代谢状态，也未表现出优先脂肪氧化。
