Bruder N, Lassegue D, Pelissier D, Graziani N, François G
Département d'Anesthésie Réanimation, Centre Hospitalo-Universitaire Timone, Marseille, France.
Crit Care Med. 1994 Jul;22(7):1114-9. doi: 10.1097/00003246-199407000-00011.
To determine the outcome of oxygen consumption (VO2) and energy expenditure after cessation of sedation in severe head-injured patients and to assess its usefulness as a predictor of neurologic severity.
Prospective, descriptive study.
Neurosurgical intensive care unit (ICU) in a university hospital.
Fifteen severe head-injured patients with tracheostomies and who were mechanically ventilated and sedated at the time of the study.
None.
VO2 and energy expenditure were measured, using indirect calorimetry during and after discontinuation of sedation. After the measurement period, the patients were divided into two groups. Group 1 included patients who were completely weaned from sedation; group 2 included patients who had to be sedated again using predetermined criteria. In both groups, energy expenditure was close to basal energy expenditure during sedation, and increased to 150% of basal energy expenditure during the recovery period, with maximum hourly values 80% above basal energy expenditure. In group 1, VO2 and energy expenditure changed from 284 +/- 44 mL/min and 1833 +/- 261 kcal/day during sedation to 390 +/- 85 mL/min and 2512 +/- 486 kcal/day for the period without sedation. During this period, there was a significant correlation between VO2 and mean arterial pressure. For the recovery period, there was no difference in mean or maximum VO2 between the two groups of patients. At 24 and 48 hrs after cessation of sedation, VO2 and energy expenditure decrease to 30% above basal energy expenditure. These changes may be due to the recovery of muscular activity, weaning from mechanical ventilation, or an increase in the amount of circulating catecholamines.
In severe head-injured patients, during the first 12 hrs after the discontinuation of sedation, the patients experienced a large increase in VO2, energy expenditure, and mean arterial pressure. Although these changes have no prognostic value in our study, they have potential deleterious effects in head-injured patients. Methods that blunt these changes which have proven efficacious in anesthesia may be effective for intensive care patients.
确定重度颅脑损伤患者镇静停止后氧耗量（VO₂）和能量消耗的结果，并评估其作为神经功能严重程度预测指标的有效性。
前瞻性描述性研究。
大学医院的神经外科重症监护病房（ICU）。
15例重度颅脑损伤且行气管切开术的患者，研究时接受机械通气和镇静治疗。
无。
在镇静期间及停止后，采用间接测热法测量VO₂和能量消耗。测量期结束后，将患者分为两组。第1组包括完全停用镇静剂的患者；第2组包括根据预定标准必须再次进行镇静的患者。两组患者在镇静期间能量消耗均接近基础能量消耗，恢复期增加至基础能量消耗的150%，每小时最高值比基础能量消耗高80%。在第1组中，VO₂和能量消耗在镇静期间分别为284±44 mL/分钟和1833±261千卡/天，在无镇静期分别变为390±85 mL/分钟和2512±486千卡/天。在此期间，VO₂与平均动脉压之间存在显著相关性。在恢复期，两组患者的平均或最大VO₂无差异。在停止镇静后24小时和48小时，VO₂和能量消耗降至比基础能量消耗高30%。这些变化可能是由于肌肉活动恢复、脱机或循环儿茶酚胺量增加所致。
在重度颅脑损伤患者中，停止镇静后的最初12小时内，患者的VO₂、能量消耗和平均动脉压大幅增加。尽管这些变化在我们的研究中没有预后价值，但对颅脑损伤患者可能具有潜在的有害影响。在麻醉中已被证明有效的减轻这些变化的方法可能对重症监护患者有效。
