不同代谢分期下重症烧伤患者静息能量消耗值的计算公式选择与分析  

Selection and analysis of calculation formulas for resting energy expenditure in patients with severe burns based on different metabolic stages

作　　者：邹文 韩春茂[1] 金荣华 沈涛 Zou Wen;Han Chunmao;Jin Ronghua;Shen Tao(Department of Burn and Wound Repair,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院烧伤与创面修复科,杭州310009

出　　处：《中华烧伤与创面修复杂志》2024年第7期634-642,共9页Chinese Journal of Burns And Wounds

基　　金：国家自然科学基金青年科学基金项目(82202443)。

摘　　要：目的探究不同代谢分期下重症烧伤患者静息能量消耗(REE)值的变化及其最佳计算公式的选择。方法该研究为回顾性观察性研究。2020年4月—2023年12月,浙江大学医学院附属第二医院收治40例符合入选标准的重症烧伤患者,其中男32例、女8例,年龄(54±17)岁。入院后,对患者实施镇静镇痛、清创、植皮等临床常规治疗。于伤后3、5、7、9、11、14 d及此后每7天,对符合测量条件的患者采用间接测热法测量REE值(即REE测量值),直到患者康复或死亡。在测量患者REE的当日,分别采用Milner公式、Hangang公式、第三军医大学公式、Carlson公式、彭曦团队线性公式计算REE值(即REE公式计算值)。统计测量患者REE的伤后时间,并对患者在急性抑制期、代谢高涨期、代谢平衡期、代谢重塑期的临床特征进行比较。统计患者在4个不同代谢分期下REE测量值以及其与REE公式计算值的差值的变化。相对于REE测量值,计算REE公式计算值的10%准确率及20%准确率以评估其准确性,计算REE公式计算值的绝对百分比误差(APE)以评估其偏离情况,筛选4个不同代谢分期中最接近REE测量值的代谢公式(即最佳计算公式),进一步地探索影响不同代谢分期下最佳计算公式准确性的关键因子。结果测量重症烧伤患者REE的时间为伤后(40±19)d。在4个不同代谢分期中,患者在代谢重塑期的年龄最大、身高最高、体重最重、体重指数最大、体表总面积最大。患者代谢重塑期的年龄显著大于急性抑制期和代谢高涨期(t值分别为-3.02、-4.20,P值均<0.05),体重显著重于代谢高涨期和代谢平衡期(t值分别为-1.97、-2.61,P值均<0.05),体重指数显著高于代谢高涨期(t=-2.90,P<0.05),体表总面积显著大于代谢高涨期和代谢平衡期(t值分别为-2.02、-2.27,P值均<0.05)。患者REE测量值在4个不同代谢分期中无显著变化(P>0.05);除彭曦团队线性公式(P>0.05)外,在Objective To explore the changes in resting energy expenditure(REE)values in patients with severe burns under different metabolic stages and the selection of the optimal calculation formula.Methods This study was a retrospective and observational study.From April 2020 to December 2023,40 patients(32 males and 8 females,aged(54±17)years)with severe burns meeting inclusion criteria were treated in the Second Affiliated Hospital of Zhejiang University School of Medicine.After admission,the patients were given routine clinical treatments such as sedation and analgesia,debridement,and skin grafting.At 3,5,7,9,11,14 days after injury and every 7 days thereafter,the REE values(i.e.,REE measured values)were measured by indirect calorimetry in patients with severe burns who met the measurement conditions till the patients recovered or died.On the day the patient's REE was measured,Milner,Hangang,the Third Military Medical University,Carlson,and Peng Xi team's linear formula were used respectively to calculate the REE value(i.e.,REE formula values).The post-injury time to measure REE in patients was calculated,and the clinical characteristics of patients in acute inhibition,hypermetabolic,metabolic balance,and metabolic remodeling phases were compared.The REE measured values and the difference between the REE formula values and the REE measured values of patients under the 4 different metabolic phases were calculated.Compared with the REE measured values,the 10%accuracy rate and 20%accuracy rate were calculated to evaluate the accuracy of the REE formula values.The absolute percentage error(APE)of the REE formula values were calculated to evaluate the deviation.The metabolic formula(i.e.,the optimal calculation formula)that was closest to the measured REE values was screened out,and further exploration was conducted to identify the key factors that affected the accuracy of the optimal calculation formula under different metabolic phases.Results The post-injury time to measure REE in patients with severe burns was(40±19)d

关 键 词：烧伤 量热法 间接 营养支持 能量代谢 静息能量消耗 重症烧伤患者 代谢分期 

分 类 号：R644[医药卫生—外科学]