Zhao Shibing, Duan Libin, Yu Gang, Zou Qi, Wu Qiang, Wang Huaxue, He Xiandi
Department of Intensive Care Unit, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui, China. Corresponding author: He Xiandi, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019 Dec;31(12):1512-1516. doi: 10.3760/cma.j.issn.2095-4352.2019.12.015.
To investigate the changing laws of rest energy expenditure (REE) in intensive care unit (ICU) patients and the intervention effect for nutritional support.
A prospective randomized control trial was conducted. Fifty-eight critically ill patients who were expected to be able to receive sustained enteral and (or) parenteral nutrition for more than 7 days admitted to ICU of the First Affiliated Hospital of Bengbu Medical College from December 2016 to June 2017 were enrolled. The patients were divided into REE group (n = 29) and HBREE group (n = 29) according to the random number table. On the 1st to 7th day after ICU admission, the indirect calorimetry and the Harris-Benedict (HB) formula were used to obtain the REE and HBREE values, and nutritional support was given according to REE and HBREE values respectively. The data of hemoglobin (Hb), albumin (Alb), prealbumin (PA), C-reactive protein (CRP), oxygenation index (OI) on 1st, 3rd, 5th, 7th and discharged day, and insulin dosage, vasopressor time, mechanical ventilation time, the length of ICU stay, and 28-day mortality were collected.
(1) At the beginning, the REE level was high, and then decreased gradually with the extension of hospitalization, and the decline was obvious on the 2nd to 3rd day (kJ/d: 7 088.38±559.41, 6 751.34±558.72 vs. 7 553.44±645.55, both P < 0.05), and was stable from the 5th day, the changing laws showed high at first, then the low, the first rapid decline, then the slow decline, and then reached the steady, there was a 2-day plateau in the middle. During the first 2 days, the REE value was significantly higher than the HBREE value (kJ/d: 7 553.44±645.55 vs. 6 759.21±668.14, 7 088.38±559.41 vs. 6 759.21±668.14, both P < 0.01); on the 3rd, 4th day, the REE value was almost the same as the HBREE value (kJ/d: 6 751.34±558.72 vs. 6 759.21±668.14, 6 568.03±760.19 vs. 6 759.21±668.14, both P > 0.05). After that, the REE value was significantly lower than the HBREE value (kJ/d: 6 089.55±560.70 vs. 6 759.21±668.14, 5 992.55±501.82 vs. 6 759.21±668.14, 5 860.84±577.59 vs. 6 759.21±668.14, all P < 0.01). (2) After the initiation of nutritional support, Hb in the REE group (the first 3 days) and HBREE group (the first 7 days) all increased slowly in the early stage. It increased obviously on the 5th day in the REE group. Compared with the REE group, Hb increased more slowly in the HBREE group, however, there was no difference between the two groups at the time of discharge (g/L: 113.75±17.28 vs. 110.86±15.35, P > 0.05). PA and OI all enhanced significantly on the 3rd day since the nutritional support was initiated, but the daily increase of the REE group was significantly higher than that of the HBREE group [3rd day, PA (mg/L): 110.38±27.65 vs. 96.28±18.06, OI (mmHg, 1 mmHg = 0.133 kPa): 259.29±49.36 vs. 231.74±28.02, both P < 0.05]. The Alb and CRP in the REE group began to improve on the 3rd day, while the index in the HBREE group was delayed on the 5th day, overall, at the time of discharge, the PA, CRP and OI were lower in the HBREE group than in the REE group [PA (mg/L): 252.28±56.94 vs. 295.86±57.26, CRP (mg/L): 73.14±17.63 vs. 56.52±14.91, OI (mmHg): 353.59±70.36 vs. 417.52±71.58, all P < 0.01]. (3) The vasopressor was used in both groups for less than 3 days, but the REE group was shorter (days: 2.26±0.82 vs. 2.95±1.22, P < 0.05), the insulin dosage in the HBREE group was much more than that in the REE group (U: 101.97±21.05 vs. 84.59±22.21, P < 0.01); compared with the REE group, the time of mechanical ventilation and the length of ICU stay in the HBREE group were longer (hours: 113.07±25.96 vs. 93.41±27.25, days: 10.41±3.11 vs. 8.45±2.44, both P < 0.01). There was no significant difference in the 28-day mortality between the REE group and HBREE group (17.24% vs. 24.14%, P > 0.05).
Indirect calorimetry can more accurately grasp the changing laws of REE in critically ill patients. Nutritional support with REE value can make relevant nutritional indicators as good as possible, and reduce insulin dosage, shorten vasopressor use time, the length of ICU stay and mechanical ventilation time, but does not change the 28-day mortality.
探讨重症监护病房（ICU）患者静息能量消耗（REE）的变化规律及营养支持的干预效果。
进行一项前瞻性随机对照试验。选取2016年12月至2017年6月蚌埠医学院第一附属医院ICU收治的预计能够接受持续肠内和（或）肠外营养7天以上的58例危重症患者。根据随机数字表将患者分为REE组（n = 29）和HBREE组（n = 29）。在ICU入院后的第1至7天，采用间接测热法和Harris-Benedict（HB）公式分别获取REE和HBREE值，并分别根据REE和HBREE值给予营养支持。收集患者第1、3、5、7天及出院当天的血红蛋白（Hb）、白蛋白（Alb）、前白蛋白（PA）、C反应蛋白（CRP）、氧合指数（OI）数据，以及胰岛素用量、血管活性药物使用时间、机械通气时间、ICU住院时间和28天死亡率。
（1）开始时REE水平较高，随后随着住院时间延长逐渐下降，在第2至3天下降明显（kJ/d：7 088.38±559.41，6 751.34±558.72 对比 7 553.44±645.55，P均<0.05），从第5天起趋于稳定，变化规律呈先高后低，先快速下降，后缓慢下降，再达到稳定，中间有2天平台期。在最初2天，REE值显著高于HBREE值（kJ/d：7 553.44±645.55 对比 6 759.21±668.14，7 088.38±559.41 对比 6 759.21±668.14，P均<0.01）；在第3、4天，REE值与HBREE值基本相同（kJ/d：6 751.34±558.72 对比 6 759.21±668.14，6 568.03±760.19 对比 6 759.21±668.14，P均>0.05）。此后，REE值显著低于HBREE值（kJ/d：6 089.55±560.70 对比 6 759.21±668.14，5 992.55±501.82 对比 6 759.21±668.14，5 860.84±577.59 对比 6 759.21±668.14，P均<0.01）。（2）营养支持开始后，REE组（前3天）和HBREE组（前7天）的Hb在早期均缓慢升高。REE组在第5天明显升高。与REE组相比，HBREE组的Hb升高更缓慢，但两组出院时无差异（g/L：113.75±17.28 对比 110.86±15.35，P>0.05）。营养支持开始后第3天，PA和OI均显著升高，但REE组的每日升高幅度显著高于HBREE组[第3天，PA（mg/L）：110.38±27.65 对比 96.28±18.06，OI（mmHg，1 mmHg = 0.133 kPa）：259.29±49.36 对比 231.74±28.02，P均<0.05]。REE组的Alb和CRP在第3天开始改善，而HBREE组的指标在第5天延迟改善，总体而言，出院时HBREE组的PA、CRP和OI低于REE组[PA（mg/L）：252.28±56.94 对比 295.86±57.26，CRP（mg/L）：73.14±17.63 对比 56.52±14.91，OI（mmHg）：
