Frankenfield D C, Omert L A, Badellino M M, Wiles C E, Bagley S M, Goodarzi S, Siegel J H
Department of Nutrition, R Adams Cowley Shock Trauma Center, Baltimore, Maryland.
JPEN J Parenter Enteral Nutr. 1994 Sep-Oct;18(5):398-403. doi: 10.1177/0148607194018005398.
Indirect calorimetry is the preferred method for determining caloric requirements of patients, but availability of the device is limited by high cost. A study was therefore conducted to determine whether clinically obtainable variables could be used to predict metabolic rate.
Patients with severe trauma or sepsis who required mechanical ventilation were measured by an open-circuit indirect calorimeter. Several clinical variables were obtained simultaneously. Measurements were repeated every 12 hours for up to 10 days.
Twenty-six trauma and 30 sepsis patients were measured 423 times. Mean resting energy expenditure was 36 +/- 7 kcal/kg (trauma) vs 45 +/- 8 kcal/kg (sepsis) (p < .0001). The single strongest correlate with resting energy expenditure was minute ventilation (R2 = 0.61, p < .0001). Doses of dopamine, dobutamine, morphine, fentanyl, and neuromuscular blocking agents each correlated positively with resting energy expenditure. In the case of the inotropics and neuromuscular blockers, there was a probable covariance with severity of illness. A multiple regression equation was developed using minute ventilation, predicted basal energy expenditure, and the presence or absence of sepsis: resting energy expenditure = -11000 + minute ventilation (100) + basal energy expenditure (1.5) + dobutamine dose (40) + body temperature (250) + diagnosis of sepsis (300) (R2 = 0.77, p < .0001).
Severe trauma and sepsis patients are hypermetabolic, but energy expenditure is predictable from clinical data. The regression equations probably apply only to severe trauma and sepsis. Other studies should be conducted to predict energy expenditure in other patient types.
间接测热法是确定患者热量需求的首选方法，但该设备因成本高昂，其可用性受到限制。因此开展了一项研究，以确定临床上可获取的变量是否可用于预测代谢率。
使用开路间接热量计对需要机械通气的严重创伤或脓毒症患者进行测量。同时获取多个临床变量。每12小时重复测量一次，最长持续10天。
对26例创伤患者和30例脓毒症患者进行了423次测量。平均静息能量消耗为创伤患者36±7千卡/千克，脓毒症患者45±8千卡/千克（p<0.0001）。与静息能量消耗相关性最强的单一因素是分钟通气量（R2=0.61，p<0.0001）。多巴胺、多巴酚丁胺、吗啡、芬太尼和神经肌肉阻滞剂的剂量均与静息能量消耗呈正相关。就血管活性药物和神经肌肉阻滞剂而言，可能与疾病严重程度存在协方差。使用分钟通气量、预计基础能量消耗以及脓毒症的有无建立了多元回归方程：静息能量消耗=-11000+分钟通气量（100）+基础能量消耗（1.5）+多巴酚丁胺剂量（40）+体温（250）+脓毒症诊断（300）（R2=0.77，p<0.0001）。
严重创伤和脓毒症患者处于高代谢状态，但能量消耗可根据临床数据预测。这些回归方程可能仅适用于严重创伤和脓毒症患者。应开展其他研究以预测其他类型患者的能量消耗。
