Dempsey D T, Guenter P, Mullen J L, Fairman R, Crosby L O, Spielman G, Gennarelli T
Surg Gynecol Obstet. 1985 Feb;160(2):128-34.
The increased energy expenditure associated with severe trauma to the head appears genuine but exhibits wide variation in its magnitude. Patients with severe acute trauma to the head without barbiturate treatment are hypermetabolic with an average energy expenditure 26 per cent over predicted. Barbiturate therapy abolishes this hypermetabolism and decreases energy expenditure to 14 per cent below predicted. In the individual patient, there appears to be a close relationship between the degree of suppression of energy expenditure and the serum barbiturate level. However, this relationship would appear to be different in each patient, and therefore, for this group, a significant correlation between energy expenditure and serum barbiturate level does not exist. The wide variability of energy expenditure in individual patients makes the estimation of energy expenditure by population predictive formulas imprecise. This may lead to incorrect estimates of caloric requirements and inappropriate provision of exogenous energy substrates. Although for those patients receiving energy expenditure and serum barbiturate levels in the individual may further aid in estimating the caloric expenditure for each individual, in order to provide appropriate amounts of calories to the patient with trauma to the head, energy expenditure should be measured in each instance.
与严重头部创伤相关的能量消耗增加似乎是确实存在的，但在程度上表现出很大差异。未接受巴比妥酸盐治疗的严重急性头部创伤患者处于高代谢状态，平均能量消耗比预测值高26%。巴比妥酸盐疗法消除了这种高代谢状态，并使能量消耗降至比预测值低14%。在个体患者中，能量消耗的抑制程度与血清巴比妥酸盐水平之间似乎存在密切关系。然而，这种关系在每个患者中似乎都不同，因此，对于该组患者，能量消耗与血清巴比妥酸盐水平之间不存在显著相关性。个体患者能量消耗的广泛变异性使得通过群体预测公式估算能量消耗不准确。这可能导致对热量需求的估计错误以及外源能量底物的供应不当。虽然对于那些接受治疗的患者，个体的能量消耗和血清巴比妥酸盐水平可能有助于进一步估算每个个体的热量消耗，但为了给头部创伤患者提供适量的热量，每次都应测量能量消耗。
