Bruder N, Raynal M, Pellissier D, Courtinat C, François G
Département d'Anesthésie-Réanimation, CHU Timone, Marseille, France.
Crit Care Med. 1998 Mar;26(3):568-72. doi: 10.1097/00003246-199803000-00033.
To quantify the effect of body temperature and sepsis on energy expenditure in head-injured patients.
Prospective, nonrandomized, observational study.
Neurosurgical intensive care unit.
Severe head-injured patients.
Use of an indirect calorimeter to measure energy expenditure.
Mean arterial pressure (MAP), heart rate (HR), body temperature, and mean hourly energy expenditure were recorded. Twenty-four patients had 1,919 hourly measures of the above parameters. The measurement periods were divided into four groups, according to the anesthetic agents used for sedation: fentanyl and midazolam (group FM); fentanyl, midazolam, and curarization (group C); thiopental (group T); and no sedation (group NS). The energy expenditure/basal energy expenditure ratio (EE/BEE) was significantly lower in group T (1.20 +/- 0.15) than in group FM (1.32 +/- 0.24) or group C (1.32 +/- 0.20) and was significantly higher in group NS (1.60 +/- 0.33). There was a significant correlation between body temperature and EE/BEE (p < .0001, r2 = .27) only in sedated patients. Using the equation of the regression line to correct energy expenditure for differences in body temperatures between groups, the difference in energy expenditure between groups with sedation disappeared. This finding suggested that the low energy expenditure under thiopental was due only to hypothermia. Sepsis significantly increased energy expenditure independently of fever. There was a weak but statistically significant correlation between energy expenditure and HR (p<.01, r2 = .13) but not between energy expenditure and MAP.
Sedation had a major effect on energy expenditure. In sedated patients, body temperature was the main determinant of energy expenditure; the anesthetic agent used had little influence on the level of energy expenditure. Sepsis increased energy expenditure independently of fever, probably through hormonal changes.
量化体温和脓毒症对颅脑损伤患者能量消耗的影响。
前瞻性、非随机、观察性研究。
神经外科重症监护病房。
重度颅脑损伤患者。
使用间接热量计测量能量消耗。
记录平均动脉压（MAP）、心率（HR）、体温和平均每小时能量消耗。24例患者对上述参数进行了1919次每小时测量。根据用于镇静的麻醉剂，测量期分为四组：芬太尼和咪达唑仑（FM组）；芬太尼、咪达唑仑和肌松剂（C组）；硫喷妥钠（T组）；未使用镇静剂（NS组）。T组的能量消耗/基础能量消耗比（EE/BEE）（1.20±0.15）显著低于FM组（1.32±0.24）或C组（1.32±0.20），而NS组显著更高（1.60±0.33）。仅在镇静患者中，体温与EE/BEE之间存在显著相关性（p<0.0001，r2 = 0.27）。使用回归线方程校正各体温组间能量消耗的差异后，镇静组间的能量消耗差异消失。这一发现表明，硫喷妥钠作用下的低能量消耗仅归因于体温过低。脓毒症可独立于发热显著增加能量消耗。能量消耗与HR之间存在弱但具有统计学意义的相关性（p<0.01，r2 = 0.13），但与MAP之间无相关性。
镇静对能量消耗有主要影响。在镇静患者中，体温是能量消耗的主要决定因素；所使用的麻醉剂对能量消耗水平影响较小。脓毒症可独立于发热增加能量消耗，可能是通过激素变化实现的。
