机械通气下IC法在外科重症患者静息能量测定中的应用价值

Clinical value of resting energy expenditure in critically ill surgical patients undergoing mechanical ventilation

关键词:  间接能耗测定法  危重症  机械通气

Key words:  indirect calorimetry  critically ill patient  mechanical ventilation

摘要:

目的　通过对比校正Harris-Benedict公式计算的静息能量消耗值(measured resting energy expenditure by Harris-Benedict，REEHB)与间接能耗测定法测量静息能量消耗值（measured resting energy expenditure by Indirect Calorimetry，REEIC），评估两者的相关性。方法　收集2015年1月至2015年11月上海市第十人民医院入住外科重症病房并行机械通气的患者33例的临床数据，计算急性生理与慢性健康状况评分(APACHEⅡ评分)。REEIC采用美国间接能耗测定法(IC法)测定；REEHB由校正Harris-Benedict公式（HB法）计算得出，分析两者的相关性。结果　REEHB与REEIC呈低正相关(r=0.512，P=0.002)，两者平均值差为 -103.9 kcal/d，95%可信区间为-819.4～611.6 kcal/d。结论　对于机械通气外科重症患者应当使用IC法对其能量消耗进行评估，指导临床营养支持。

Abstract:

Objective　To compare the adjusted Harris-Benedict formula calculating resting energy expenditure (REEHB) with indirect calorimetry (IC) measured resting energy expenditure (REEIC) in the mechanically ventilated critically ill surgical patients and to evaluate the relationship between them. Methods　 Thirty-three patients undergoing mechanical ventilation for critical ill surgical patients in the intensive care unit between January 2015 and November 2015 were included in this study. Data during the study period of nutrition support were collected for computation of the severity of critical illness by acute physiology and chronic health evaluation Ⅱscores (APACHE Ⅱ scores). REEIC was measured by using IC. REEHB was calculated by using the Harris-Benedict formula adjusted with correction factors for illness at the same time. The differences between REEHB and REEIC of patients in two groups were analyzed. Results　REEHB had significant (P=0.002) but low correlation (Spearman r=0.512) with REEIC, with a mean bias of -103.9 kcal/d and limits of agreement ranging from -819.4 to 611.6 kcal/d as detected by the Bland-Altman analysis. Conclusion　REEIC seems to be more appropriate than REEHB for accurate measurement of REE in critically ill surgical patients under mechanical ventilation.