Coss-Bu J A, Jefferson L S, Walding D, David Y, Smith E O, Klish W J
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Nutrition. 1998 Sep;14(9):649-52. doi: 10.1016/s0899-9007(98)00050-1.
Nutritional support is important in critically ill patients, with variable energy and nitrogen requirements (e.g., sepsis, trauma, postsurgical state) in this population. This study investigates how age, severity of illness, and mechanical ventilation are related to resting energy expenditure (REE) and nitrogen balance. Nineteen critically ill children (mean age, 8 +/- 6 [SD] y and range 0.4-17.0 y) receiving total parenteral nutrition (TPN) were enrolled. We used indirect calorimetry to measure REE. Expected energy requirements (EER) were obtained from Talbot tables. Pediatric Risk of Mortality (PRISM) and Therapeutic Intervention Scoring System (TISS) score were calculated. Total urinary nitrogen was measured using the Kjeldahl method. PRISM and TISS scores were 9 +/- 5 and 31 +/- 6 points, respectively. REE was 62 +/- 25 kcal.kg-1.d-1, EER was 42 +/- 11 kcal.kg-1. d-1, and caloric intake was 49 +/- 22 kcal.kg-1.d-1. Nitrogen intake was 279 +/- 125 mg.kg-1.d-1, total urinary nitrogen was 324 +/- 133 mg.kg-1.d-1, and nitrogen balance was -120 +/- 153 mg.kg-1.d-1. The protein requirement in this population was approximately 2.8 g.kg-1.d-1. These critically ill children were hypermetabolic, with REE 48% higher (20 kcal.kg-1.d-1) than expected. Nitrogen balance significantly correlated with caloric and protein intake, urinary nitrogen, and age, but not with severity of illness scores or ventilatory parameters.
营养支持对危重症患者很重要，该人群的能量和氮需求各不相同（如脓毒症、创伤、术后状态）。本研究调查年龄、疾病严重程度和机械通气如何与静息能量消耗（REE）和氮平衡相关。纳入了19名接受全胃肠外营养（TPN）的危重症儿童（平均年龄8±6[标准差]岁，范围0.4 - 17.0岁）。我们使用间接测热法测量REE。预期能量需求（EER）通过塔尔博特表获得。计算儿科死亡风险（PRISM）和治疗干预评分系统（TISS）得分。采用凯氏定氮法测量总尿氮。PRISM和TISS得分分别为9±5分和31±6分。REE为62±25 kcal·kg⁻¹·d⁻¹，EER为42±11 kcal·kg⁻¹·d⁻¹，热量摄入为49±22 kcal·kg⁻¹·d⁻¹。氮摄入量为279±125 mg·kg⁻¹·d⁻¹，总尿氮为324±133 mg·kg⁻¹·d⁻¹，氮平衡为 -120±153 mg·kg⁻¹·d⁻¹。该人群的蛋白质需求量约为2.8 g·kg⁻¹·d⁻¹。这些危重症儿童处于高代谢状态，REE比预期高48%（20 kcal·kg⁻¹·d⁻¹）。氮平衡与热量和蛋白质摄入、尿氮及年龄显著相关，但与疾病严重程度评分或通气参数无关。
