Long C L, Schaffel N, Geiger J W, Schiller W R, Blakemore W S
JPEN J Parenter Enteral Nutr. 1979 Nov-Dec;3(6):452-6. doi: 10.1177/014860717900300609.
The metabolic response to injury and illness as manifested by increases in energy expenditure and nitrogen losses makes it difficult for the clinician to evaluate calorie and protein needs. A method for determining daily calorie needs in hospitalized patients is presented. Average increases in resting metabolic expenditure for a group of patients following elective operation, skeletal trauma, skeletal trauma with head injury, blunt trauma, sepsis and burns were determined by indirect calorimetry and protein need by urinary nitrogen losses over extended time periods. Total daily calorie needs were then calculated, using the Harris-Benedict equation and adjusting this value upward using a previously measured activity and injury factor to arrive at the daily needs. Protein requirements may be determined on periodic 24 hour urine samples analyzed for the urinary urea nitrogen and adjusting this to a total nitrogen or protein equivalent. This approach to estimating the calorie nitrogen needs of the hospitalized patient under various degrees of stress more closely approximates the patient's variable needs at the height of the catabolic response and during convalescence.
由能量消耗增加和氮损失所体现出的对损伤和疾病的代谢反应，使得临床医生难以评估热量和蛋白质需求。本文介绍了一种确定住院患者每日热量需求的方法。通过间接测热法测定了一组接受择期手术、骨骼创伤、伴有头部损伤的骨骼创伤、钝性创伤、败血症和烧伤的患者静息代谢消耗的平均增加量，并通过长时间的尿氮损失来确定蛋白质需求。然后使用哈里斯-本尼迪克特方程计算每日总热量需求，并使用先前测量的活动和损伤系数向上调整该值以得出每日需求。蛋白质需求量可通过定期采集24小时尿液样本，分析其中的尿素氮，并将其调整为总氮或蛋白质当量来确定。这种估算不同应激程度下住院患者热量-氮需求的方法，更接近患者在分解代谢反应高峰期和康复期间的变化需求。
