Saffle J R, Medina E, Raymond J, Westenskow D, Kravitz M, Warden G D
J Trauma. 1985 Jan;25(1):32-9. doi: 10.1097/00005373-198501000-00006.
The use of indirect calorimetry in assessing and monitoring nutritional support in burn patients is reported. Twenty-nine patients with a mean burn size of 35% TBSA were monitored with 228 measurements of resting energy expenditure (REE), calculations of respiratory quotient (RQ), and substrate metabolism. Daily weights, nitrogen balance determinations, and routine laboratory tests were also obtained. Oxygen consumption (VO2) was 186 +/- 39 ml/min/M2, corresponding to REE of 2,506 +/- 543 kcal/day. REE varied during the course of wound healing, demonstrating a biphasic course. Metabolic rate was also significantly increased with the performance of routine procedures such as dressings and surgery. Measurements of REE were a mean 76% of predictions based on the Curreri formula, and 1.47 times basal energy expenditure (BEE) calculated by the Harris-Benedict equation. Neither formula provided for the great variations observed in daily, and individual, measurements of REE. During the study, patients consumed 2,900 +/- 811 kcal/day, which exceeded REE by 1.14. This was associated with mean weight loss of 3.2% (range, -16 to 9%). RQ was less than 0.85 in 9% of determinations, but exceeded 1.0 24% of the time. Protein accounted for 17 +/- 3% of total metabolism, corresponding to a calorie:nitrogen ratio of 128:1. Practically, however, provision of this much protein proved difficult. Routine use of indirect calorimetry permits tailoring of nutritional support for burn patients, and is valuable in the early detection of significant under- or overnutrition.
报告了间接测热法在评估和监测烧伤患者营养支持中的应用。对29例平均烧伤面积为35%体表面积的患者进行了228次静息能量消耗（REE）测量、呼吸商（RQ）计算和底物代谢监测。还获取了每日体重、氮平衡测定结果和常规实验室检查结果。氧耗量（VO2）为186±39 ml/min/M2，对应REE为2506±543 kcal/天。REE在伤口愈合过程中有所变化，呈现双相过程。常规操作如换药和手术也会使代谢率显著升高。REE测量值平均为基于Curreri公式预测值的76%，是通过Harris-Benedict方程计算的基础能量消耗（BEE）的1.47倍。这两个公式均未考虑到REE每日及个体测量中观察到的巨大差异。研究期间，患者每日消耗2900±811 kcal，比REE超出1.14。这与平均体重减轻3.2%（范围为-16%至9%）相关。9%的测定中RQ小于0.85，但24%的时间超过1.0。蛋白质占总代谢的17±3%，对应热量:氮比为128:1。然而，实际上提供这么多蛋白质很困难。间接测热法的常规使用有助于为烧伤患者量身定制营养支持，并且在早期发现严重营养不足或营养过剩方面很有价值。
