Comparison between Measured and Predicted Resting Energy Expenditure in Mechanically Ventilated Patients with COPD

用机械通气的慢性阻塞性肺病患者测定的与预测的静息能量消耗之比较及临床应用分析

Zhi-Yong Rao ； Xiao-Ting Wu ； Mao-Yun Wang ； Wen Hu

《Asia Pacific Journal of Clinical Nutrition》 21卷3期 (2012/09) Pp. 338-346

https://doi.org/10.6133/apjcn.2012.21.3.03

摘要

为了研究机械通气的慢性阻塞性肺病（COPD）患者的能量代谢特点，比较间接测热法测定与Harris-Benedict公式预测的静息能量消耗（REE）的差异。并以此为依据，分析低能量的营养支持是否能改善患者蛋白质营养状况。纳入了33例（男20例，女13例）COPD患者，并测定其REE。比较测定的REE（REEm）和HB公式计算的REE（REEH-B）及其校正值之间的差异，同时还分析了REEm与APACHEⅡ评分之间的关系。33例患者被随机分成低能量组（REEm的50%－90%）和常规能量组（REEm的90%－130%），按照以上标准进行营养支持。比较营养支持前和支持后7天的白蛋白、前白蛋白、转铁蛋白、血红蛋白和淋巴细胞计数。REEH-B和用1.2校正的值均明显低于REEm（p＜0.01）；REEm与APACHEⅡ评分之间存在正相关（p＜0.05或p＜0.01）。营养支持后，常规能量组的血红蛋白明显降低（p＜0.05），两组患者的淋巴细胞计数，以及常规能量组的转铁蛋白和前白蛋白均明显升高（p＜0.05或p＜0.01）。结果提示：1）机械通气的COPD患者的REE升高；2）间接测热法是确定REE的最好方法，在不能作间接测热法時，Harris-Benedict公式可用于计算患者的REE，但要参照APACHEⅡ评分予以校正；3）低能量的营养支持在改善机械通气COPD患者的蛋白质营养状况优于常规能量的营养支持。

關鍵字

静息能量消耗 ； 间接测热法 ； 机械通气 ； APACHEⅡ评分 ； 能量消耗预测公式

並列摘要

The aim of this study was to compare resting energy expenditure (REE) obtained by indirect calorimetry (IC) and Harris-Benedict (H-B) equations, and to examine whether hypocaloric nutrition support could improve protein nutritional status in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD). Thirtythree COPD patients (20 males, 13 females) were recruited and REE was measured by IC. Measured REE (REEm) was compared to predictive REE by H-B equations (REEH-B) and its corrected values. Correlation between REEm and APACHE II score was also analyzed. Patients were randomly divided into hypocaloric energy group (50%-90% of REEm, En-low) and general energy group (90%-130% of REEm, En-gen) for nutrition support. The differences of albumin, prealbumin, transferrin, hemoglobin, and lymphocyte count before and after 7 days nutrition support were observed. Results show that REEH-B and REEH-B×1.2 were significantly lower than REEm (p＜0.01). REEm positively correlated with APACHE II score (p＜0.05 or p＜0.01). After nutrition support, hemoglobin decreased significantly in En-gen group (p＜0.05); lymphocyte count in both groups, and transferrin and prealbumin in the En-low group increased significantly (p＜0.05 or p＜0.01). Our data suggest that 1) these patients' REE were increased; 2) since IC is the best method to determine REE, in the absence of IC, H-B equations (with standard body weight) can be used to calculate REE, but the value should be adjusted by correction coefficients derived from APACHE II; 3) low energy nutrition support during mechanical ventilation in COPD patients might have better effects on improving protein nutritional status than high energy support.

並列關鍵字

resting energy expenditure ； indirect calorimetry ； mechanical ventilation ； APACHE II score ； predictive equation for energy expenditure