Khorram-Sefat R, Behrendt W, Heiden A, Hettich R
Department of Burns and Plastic Surgery, University of Technology Aachen, Pauwelsstrasse, D-52057 Aachen, Germany.
World J Surg. 1999 Feb;23(2):115-22. doi: 10.1007/pl00013172.
The objective of this study was to evaluate resting energy expenditure (REE) in spontaneously breathing and artificially ventilated burn patients during the entire intensive care period. In 27 patients with 51 +/- 20% body surface area burned (BSAB) the REE was determined via indirect calorimetry. Three groups were formed according to the mortality prognosis index of Zawacki et al. In groups A, B, and C the predicted mortality rates were <20%, 20% to 80%, and >80%, respectively. The frequency of acute respiratory distress syndrome (ARDS), sepsis, renal failure, and mortality increased from group A toward group C. The REE test revealed wide individual variation and was usually overestimated by all tested formulas. The mean REE was comparable in groups A, B, and C during the first 20 days (49 +/- 16% vs. 59 +/- 21% vs. 57 +/- 18% above the REE calculated by the Harris-Benedict equation, or HBEE). The REE of patients in groups A and B declined after this period, whereas the long-term ventilated patients in the prognostically unfavorable group C showed a high REE up to the 45th day, usually accompanied by severe organ dysfunction and major metabolic disorders. During this time a nutritional regimen meeting the actual REE could not be achieved. In the clinical situation when indirect calorimetry is not available, REE can be stated to be 50% to 60% above HBEE in patients with >20% BSAB for at least 20 days. Expecting a stable clinical course in patients with a predicted mortality of <20% (group A), oral nutrition usually seems sufficient after a short period of artificial nutritional support (1 week). Patients with a predicted mortality of more than 20% have a complication-burdened clinical course and a prolonged period of ventilation (groups B and C). These patients need parenteral and enteral nutrition for at least 20 days after trauma to prevent severe malnutrition.
本研究的目的是评估在整个重症监护期间，自主呼吸和人工通气的烧伤患者的静息能量消耗（REE）。对27例烧伤体表面积（BSAB）为51±20%的患者，通过间接测热法测定REE。根据Zawacki等人的死亡率预后指数分为三组。A、B、C组的预测死亡率分别为<20%、20%至80%和>80%。急性呼吸窘迫综合征（ARDS）、脓毒症、肾衰竭的发生率以及死亡率从A组到C组逐渐增加。REE检测显示个体差异很大，所有测试公式通常都会高估REE。在最初20天内，A、B、C组的平均REE相当（比哈里斯- Benedict方程计算的REE，即HBEE高出49±16% vs. 59±21% vs. 57±18%）。此后，A组和B组患者的REE下降，而预后不良的C组长期通气患者在第45天前REE一直很高，通常伴有严重器官功能障碍和主要代谢紊乱。在此期间，无法实现符合实际REE的营养方案。在无法进行间接测热法的临床情况下，对于烧伤体表面积>20%的患者，至少20天内，REE可设定为比HBEE高50%至60%。对于预测死亡率<20%（A组）的患者，若预期临床过程稳定，在短期人工营养支持（1周）后，口服营养通常似乎就足够了。预测死亡率超过20%的患者临床过程并发症负担重，通气时间延长（B组和C组）。这些患者在创伤后需要肠外和肠内营养至少20天，以预防严重营养不良。
