烧伤早期能量消耗变化的临床研究

目的:调查烧伤后1~7 d能量消耗(REE)的基本改变,以指导烧伤早期患者的营养治疗。方法:实测75例烧伤患者的REE,测点为烧伤后1、2、3和7 d,13名正常人测定值作为对照。结果:患者伤后1 d的REE与烧伤面积呈负相关(r=-0.658,P<0.05);伤后2、3 d则相关性不显著(r分别为-0.207和-0.264,P>0.05);而伤后7 d则为正相关(r=0.890,P<0.05)。REE的变化可分为缓升期和高代谢期,伤后REE不升或升高后又迅速降低者提示预后不良。结论:大面积烧伤患者伤后早期REE有明显的缓升阶段,营养补充应有计划进行,切忌过量补给。     

烧伤后能量消耗与创面深度的关系

目的:调查烧伤总面积基本相同而创面深度不同与能量消耗(REE)的关系,以指导烧伤患者的营养治疗。方法:将23例烧伤总面积基本相同而三度烧伤面积不同的患者分为4组,它们的烧伤总面积和三度烧伤面积分别是:A组(66±18)%、(12±9)%;B组(59±18)%、(20±5)%;C组(62±6)%、(39±5)%;D组(65±16)%、(54±4)%。间接测热法测定各烧伤组的REE,测定点为烧伤后(PBD)1、2、3、7、14、21和28 d。13例健康正常人测定值作为对照。结果:各烧伤组REE均值均高于正常对照,组间REE随三度烧伤面积的增加而递增,并有统计学意义(P<0.05)。结论:烧伤后REE明显升高,烧伤总面积相同,三度烧伤面积越大REE升高越明显,营养治疗时,能量补充应酌情增加。     

烧伤后静息能量消耗与烧伤面积的关系

75例烧伤病员静息能量消耗(REE)与烧伤面积及创面深度关系调查的结果显示:REE随烧伤面积的增加而升高;烧伤总面积相同,Ⅲ度面积大者,REE升高明显;创面愈合后短期内REE仍然明显高于正常。     

慢性阻塞性肺病患者静息能量消耗

研究慢性了阻塞性肺病患者机体能量消耗变化并探讨其与肺功能损害程度的关系。测定６２例ＣＯＰＤ缓解期患者静息能量消耗并与４１例健康老人测定值比较，结果：各年龄组ＣＯＰＤ患者ＲＥＥ占预计值百分比均明显高于对照组，气道阻塞程度越严重，ＲＥＥ％越高，第一秒用力呼气容积占预计值百分比与ＲＥＥ％呈负相关，ＦＥＶ１与用 力肺活量之比与Ｒ ＥＥ％也呈负相关。（ｒ＝０．５９，Ｐ＜０．００１）。结论：研究结果可用于ＣＯ     

中老年糖尿病患者静息能量消耗

目的探讨中老年糖尿病(DM)患者静息能量消耗(REE)与性别、年龄、人体测量学指标的相关性。方法用间接能量测定仪测定31例(男11例、女20例)DM中老年人的REE水平,并将REE实测值与根据Harris-Benedict公式算出的基础能量消耗值(BEE)进行比较;同时应用生物电阻抗分析法(BIA)测定去脂体质量(FFM)和体脂重量(FM)等人体测量学数据。结果 DM患者的REE平均值为(1 336.97±273.48)kcal/24h,与用H-B公式计算的BEE相比较差异有统计学意义;并分别与身高、体质量、腰围、体表面积(BSA)、体质量指数(BMI)、FFM、脉搏、腰臀比(WHR)之间有统计学意义的相关性。其中FFM(r=0.615)有强相关性。结论 H-B公式不适合中老年DM患者。公式过高估计了中老年DM患者的BEE,由于中老年DM患者的REE存在较大的个体差异,其REE值宜实测而不宜用公式预测。中老年DM患者的REE与腰围、BSA、BMI、FFM、WHR间有强相关性。     

冠状动脉慢血流患者心肌能量消耗水平变化及意义

目的 探讨冠状动脉慢血流患者超声心电图的心脏结构、功能指标以及心肌能量消耗水平(MEE)的改变及其意义。方法 选取2019年1月至2020年1月在佛山市第二人民医院因胸痛住院行冠脉造影并确诊冠状动脉慢血流的患者78例作为冠脉慢血流组(CSF组),冠脉造影正常者77例作为正常对照组(CNF组)。应用超声心动图、组织多普勒技术分别测量心脏结构指标、左室收缩、舒张功能指标(LVEF,Mitral E/A,Mitral e′),计算左室收缩末周向室壁应力(cESS)、MEE。结果 CSF组与CNF组间左心室质量指数(LVMI)、收缩期左室后壁厚度(PWTs)、主动脉瓣瓣环直径(AD)比较,差异无统计学意义(P0.05)。CSF组收缩期左心室内径(LVIDs)大于正常对照组,主动脉瓣射血速度(AV)减慢,射血时间(LVET)延长,差异有统计学意义(P0.05);两组间左心室收缩功能比较、左心室射血分数(LVEF)比较,差异无统计学意义;左心室舒张功能指标E/A比值两组间差异无统计学意义(P0.05),但反映左心室舒张功能更灵敏的指标二尖瓣游离壁及室间隔瓣环舒张早期峰值速度均值(e′),两组差异有统计学意义(P0.05)。与CNF组相比,CSF组心肌能量消耗指标(cESS、MEE)均有增加,差异有统计学意义(P0.05)。结论 冠状动脉慢血流患者由于心肌灌注不足,导致部分心脏结构指标改变,伴随一定程度的舒张功能减退,左心室射血时间延长,主动脉瓣血流速度减低,心肌能量消耗增加。     

慢性阻塞性肺病患者静息能量消耗

研究慢性阻塞性肺病（ＣＯＰ）患者机体能量消耗变化并探讨其与肺功能损害程度的关系。测定 ６２例ＣＯＰＤ缓解期患者静息能量消耗（ＲＥＥ）并与４１例健康老人测定值比较。结果：各年龄组ＣＯＰＤ患者ＲＥＥ占预计值百分比（ＲＥＥ％）均明显高于对照组（Ｐ＜０.００１），气道阻塞程度越严重，ＲＥＥ％越高，第一秒用力呼气容积（ＦＥＶ１）预计值百分比（ＦＥＶ１％）与 ＲＥＥ％呈负相关（ｒ＝－０．７３， Ｐ＜０．００１），ＦＥＶ１与用力肺活量之比（ＦＥＶ１／ＦＶＣ与ＲＥＥ％也呈负相关（ｒ＝－０．５９，Ｐ＜０．００１）。结论：研究结果可用于ＣＯＰＤ患者营养治疗时营养处方的计算，也便于对肺功能损害程度不同的ＣＯＰＤ患者营养素摄入情况进行比较。     

烧伤病人应用改善代谢药物125例调查分析

严重烧伤可使机体发生一系列的应激反应,主要表现为高能量消耗和高分解代谢紊乱,这种超高代谢可迅速加重机体组织细胞的结构和功能损害,增加烧伤并发症与死亡率。进行烧伤的支持治疗,使机体的代谢处于适当水平,已成为治疗烧伤的要点之一,本文就该方法对我院烧伤中心125例烧伤病例进行了回顾性调查分析,总结如下。1资料与方法1.1临床资料随机抽取太钢烧伤中心1999年6月—2004年1月住院病例125例进行调查分析。其中,男96例,女29例,最大年龄79岁,最小年龄7个月,平均(20.00±18.86)岁,烧伤面积0.5%~97%。分析内容包括:姓名、性别、年龄、住院号…     

Comparison of five equations for estimating resting energy expenditure in Chinese young,normal weight healthy adults

Background

Most resting energy expenditure (REE) predictive equations for adults were derived from research conducted in western populations; whether they can also be used in Chinese young people is still unclear. Therefore, we conducted this study to determine the best REE predictive equation in Chinese normal weight young adults.

Methods

Forty-three (21 male, 22 female) healthy college students between the age of 18 and 25 years were recruited. REE was measured by the indirect calorimetry (IC) method. Harris-Benedict, World Health Organization (WHO), Owen, Mifflin and Liu’s equations were used to predictREE (REEe). REEe that was within 10% of measured REE (REEm) was defined as accurate. Student’s t test, Wilcoxon Signed Ranks Test, McNemar Test and the Bland-Altman method were used for data analysis.

Results

REEm was significantly lower (P < 0.05 or P < 0.01) than REEe from equations, except for Liu’s, Liu’s-s, Owen, Owen-s and Mifflin in men and Liu’s and Owen in women. REEe calculated by ideal body weight was significantly higher than REEe calculated by current body weight ( P < 0.01), the only exception being Harris-Benedict equation in men. Bland-Altman analysis showed that the Owen equation with current body weight generated the least bias. The biases of REEe from Owen with ideal body weight and Mifflin with both current and ideal weights were also lower.

Conclusions

Liu’s, Owen, and Mifflin equations are appropriate for the prediction of REE in young Chinese adults. However, the use of ideal body weight did not increase the accuracy of REEe.     

危重症患者能量消耗测定及早期营养支持达标分析

目的利用间接能量测定法测定危重症患者能量消耗情况,分析患者代谢特点与营养达标情况。方法对收治的78例机械通气患者,按照营养支持能量是否达到预测值(REE)的60%分为达标组(32例)和未达标组(46例)利用间接测热仪测定其静息能量消耗实测值,并用harris-benedict公式计算的预测值进行比较,判断患者能量消耗情况,通过计算能量供给量分析患者营养支持达标情况。结果测试结果显示患者REE值一般为预测值的1.12～1.31倍。达标组内,低代谢状态和正常代谢状态合计占87.5%,未达标组中,低代谢状态和高代谢状态合计占54.3%。两组相比较差异有统计学意义(P<0.05)。达标组肠内营养支持和肠内,肠外联合营养支持的使用率71.8%明显高于未达标组43.38%,两组有统计学意义(P<0.05)。结论危重症患者静息能量实测值高于公式计算的预测值,但并非所有患者的静息能量实测值都高于公式计算的预测值。低代谢状态和正常代谢状态患者较易实现营养达标。使用肠内营养可提高营养达标率,在有条件的情况下,尽量使用。     

Daily systemic energy expenditure in the acute phase of aneurysmal subarachnoid hemorrhage

Abstract

Background: Patients with subarachnoid hemorrhage often have impaired consciousness and cannot regulate nutritional intakes themselves. Previous studies have demonstrated elevated energy expenditure in the acute phase, but it is not known whether the energy demand is constant during the first week after onset of the disease. In this study, we performed daily measurements of energy expenditure with indirect calorimetry during the first 7 days after aneurysmal subarachnoid hemorrhage in mechanically ventilated patients.

Methods: Metabolic measurements were performed daily with indirect calorimetry in 26 patients with aneurysmal subarachnoid hemorrhage. All patients were intubated and mechanically ventilated. The measured value was compared to the predicted values from the Harris–Benedict equation and the Penn State University 1998 equation. Urinary nitrogen excretion was measured daily.

Results: There was a significant increase in energy expenditure during days 2–3 compared to days 5–6. The Harris–Benedict equation underestimated metabolic demand. The Penn State 1998 equation was closer to the measured values, but still underestimated caloric need. Urinary nitrogen excretion increased throughout the first week from initially low values.

Conclusions: There is a dynamic course in energy expenditure in patients with aneurysmal subarachnoid hemorrhage, with increasing metabolic demand during the first week of the disease. Indirect calorimetry could be used more often to help provide an adequate amount of energy.     

老年胃肠道肿瘤患者静息能量代谢特点

目的观察老年胃肠道肿瘤病人静息能量代谢（Resting Energy Expenditure,REE）的特点。方法选择老年（≥60岁）胃肠道肿瘤患者和非肿瘤患者（对照组）各60例,应用间接测热仪对其进行REE测定,根据MNA法评价营养状况,计算Harris-Benedict公式预测值。结果老年男性肿瘤患者REE较对照组低,且差异有统计学意义;H-B公式预测值明显高于REE测定值,差异有统计学意义;临床估计能量供给的经验值平均为REE测量值的1.5倍。结论老年胃肠道肿瘤患者静息能量消耗较非肿瘤患者有所下降,H-B公式法不能准确预测病人的能量消耗,经验估计值可能会造成过度喂养。     

Resting energy expenditure and its relationship with patterns of obesity and visceral fat area in Chinese adults

INTRODUCTION Obesity increases the risk of type2diabetes,hypertension,dyslipidemia,atherosclerosis,several types of cancer and many other diseases.These diseases have been shown more closely related to the accumulation of visceral(intra-abdominal)adipose …     

不同体重成年人静息能量消耗分析

目的间接测量法了解不同体重成年人静息代谢消耗（Resting Energy Expenditure,REE）,并与Harris-Benedict预测公式进行比较。方法选取健康成年人601例,其中男性426例,女性175例,年龄（48.85±8.21）岁,身高（169.2±7.23）cm,体质量（72.8±10.91）kg,体质量指数为（25.37±2.93）kg/m2。采用可携带式MedGem间接能量测量仪,按BMI〈24kg/m2、BMI 24-27.9kg/m2和BMI≥28kg/m2分为三组,生物电阻抗法人体成分分析;按Harris-Benedict公式计算REE。结果 REE测量值男性（6 788.37±812.55）kJ/d,比公式预测值高10%;女性（5 605.04±725.56）kJ/d,比公式预测值高1.5%。REE测量值随BMI增加,但当去除了去脂组织重（Fat Free Mass,FFM）对REE的因素后,男性的REE/FFM值反而低于女性。REE测量值与HB公式值间的偏倚随BMI增加而增大,平均54.4%的预测值在临床可接受的范围内。结论可携带式MedGem间接能量测量仪方法简便,对指导个体化营养和体重控制有临床实用意义。     

烫伤幼儿静息能量消耗测定

目的　测定烫伤患儿静息能量消耗 ,为临床营养支持能量估算提供依据。方法　选择 1～ 4岁年龄组2 0例 °烫伤、面积 8%～ 35 %的幼儿作为研究对象。用间接热卡仪 ,在烫伤后 1～ 14天内进行 34次静息能量消耗(resting energy expenditure,REE)的测定 ,并与同年龄组 12 7例正常儿童 REE值做对比。结果　烫伤患儿 REE为2 72 .3± 48.49(k J· kg- 1 / 2 4h)。统计分析表明 ,烫伤组 REE较 12 7例正常组 2 43.5 5± 35 .44 (k J· kg- 1 / 2 4h)有显著性差异 (P=0 .0 0 2 ) ,约为正常组的 1.12倍。REE亦与烫伤面积呈正相关。结论　临床上对 °烫伤患儿确有必要进行营养干预。