Monk D N, Plank L D, Franch-Arcas G, Finn P J, Streat S J, Hill G L
University Department of Surgery, Auckland Hospital, New Zealand.
Ann Surg. 1996 Apr;223(4):395-405. doi: 10.1097/00000658-199604000-00008.
Understanding the changes in energy expenditure and body composition is essential for the optimal management of the critically injured, yet these changes have not been quantified within the current context of trauma care.
Ten critically injured patients (median Injury Severity Score = 35) had measurements of energy expenditure and body composition as soon as they were hemodynamically stable and then every 5 days for 21 days.
Resting energy expenditure rose to 55% above predicted and remained elevated throughout the study period. Total energy expenditure was 1.32 X resting energy expenditure. Body fat was oxidized when energy intake was insufficient (r=-0.830, p<0.02). Body water changes closely paralleled body weight changes and were largely accounted for by changes in extracellular water. Over the 21-day study period, there was a loss of 1.62 kg (16%) of total body protein (p<0.0002), of which 1.09 kg (67%) came from skeletal muscle. Intracellular potassium was low (133 +/- 3 mmol/L, p<0.02) but did not deteriorate further after hemodynamic stability had been reached.
These results show that the period of hypermetabolism lasts longer and the protein loss is greater in critically injured patients than previously thought. Most, but not all, the protein is lost from muscle. Fat loss can be prevented and cell composition preserved once hemodynamic stability is achieved.
了解能量消耗和身体成分的变化对于重症创伤患者的最佳管理至关重要，但在当前创伤护理背景下，这些变化尚未得到量化。
10例重症创伤患者（损伤严重度评分中位数 = 35）在血流动力学稳定后立即进行能量消耗和身体成分测量，随后每5天测量一次，共测量21天。
静息能量消耗升至高于预测值55%的水平，并在整个研究期间持续升高。总能量消耗为静息能量消耗的1.32倍。当能量摄入不足时，身体脂肪被氧化（r = -0.830，p < 0.02）。身体水分变化与体重变化密切平行，主要由细胞外液变化引起。在21天的研究期间，全身蛋白质损失1.62 kg（16%）（p < 0.0002），其中1.09 kg（67%）来自骨骼肌。细胞内钾含量较低（133 ± 3 mmol/L，p < 0.02），但在达到血流动力学稳定后未进一步恶化。
这些结果表明，重症创伤患者的高代谢期持续时间比以前认为的更长，蛋白质损失更大。大部分但并非全部蛋白质从肌肉中流失。一旦实现血流动力学稳定，脂肪损失可以预防，细胞成分得以保留。
