使用間接能量測定法與估算能量公式探討使用呼吸器之重症病患的能量需要並評估其營養狀況

加護病房（intensive care unit; ICU）使用呼吸器的重症病人普遍存在著營養不良的問題。然而多數使用呼吸器的重症病人有嚴重的臨床狀況，一般估算能量需要的公式並不一定能正確的估算出病人實際能量需要。因此本篇的研究目的為：1)評估病人的營養狀況。2)利用間接能量測定法測量使用呼吸器之重症病人的實際基本能量消耗。3)比較實際測量與公式估算出的能量需要的差異度並探討其相關性。 方法：本實驗受測者共有46位，依其使用營養支持的方式分為腸道營養（EN）、靜脈營養（TPN）以及合併腸道及靜脈營養（combined）。病人的營養狀況是利用體位測量、生化檢驗、營養素攝取及重症程度加以評估。病人的實際能量消耗是以DeltatracTM II MBM-200 Metabolic Monitor測量。另外病人的能量需要也利用Harris-Benedict，Kleiber，Liu，Ireton-Jones及Fusco等公式估算。 結果：病人的體位測量和生化檢驗除了ferritin之外都低於正常值。病人以間接能量測定法測出的基本能量消耗平均為1631 ± 345 kcal/d與病患的能量攝取量1822 ± 439 kcal/d有顯著差異。Harris-Benedict、Kleiber、Liu以及Ireton-Jones等公式所估算出的能量需要有低估、高估或適當估算病人的實際能量消耗的情形，然而在乘上預估的壓力因子1.2之後則無顯著差異。Fusco公式不論在乘上預估的壓力因子1.2之前或之後皆無顯著差異。病人的實際能量消耗與所有公式呈顯著正相關（r = 0.480-0.783；p < 0.01）。 結論：加護病房重症病人呈顯著營養不良的情形。間接能量測定是比較適宜用來評估重症病患能量需要的方法，但若無法以間接能量測定法測得病人的實際能量需要，將Harris-Benedict、Kleiber及Liu等公式乘上適當的壓力因子（1.2）或許可以作為估算重症病人能量需要的公式。

Background: The prevalence of malnutrition is a common problem in hospitalized patients, especially in critically ill patients. All most critically ill patients with mechanically ventilated have severe clinical conditions, estimated equations may not be useful for patients. Purpose: 1) to assess nutritional status; 2) to measure actual resting energy expenditure by using indirect calorimetry ; 3) to compare measured and estimated resting energy expenditure in mechanically ventilated critically ill patients. Methods: Forty-six patients in the ICU were divided into enteral nutrition (EN), total parenteral nutrition (TPN) or combined nutrition (EN plus TPN) groups. Anthropometric and biochemical measurements, macronutrient intakes and medical status were assessed. The Deltatrac TM II MBM-200 Metabolic Monitor was used to measure actual energy expenditure of patients. Harris-Benedict, Kleiber, Liu, Ireton-Jones and Fusco equations were used to estimate energy requirements of patients. Results: Patients had abnormal mean anthropometric and biochemical measurements. The mean measured actual energy expenditure (1631 ± 345 kcal/d) of patients was significant different from patients’ calories intake (1822 ± 439 kcal/d). The equations of Harris-Benedict, Kleiber, Liu, and Ireton-Jones underestimated, overestimated, or reasonably estimated REE in patients. The use of an estimated stress factor (1.2) times REE estimated by Harris-Benedict, Kleiber, and Liu equations were comparable to and correlated with the measured resting energy expenditure (MREE) in any groups. The Fusco equation did not show significant differences when compared with the values of MREE in 3 groups. The MREE of patients was significantly positively correlated with all equations (r = 0.480-0.783, p < 0.01). Conclusions: Patients were in malnutrition. Measurement of metabolic rates by using indirect calorimetry in mechanically ventilated critically ill patients is generally not routine in the hospitals of Taiwan. Our results demonstrated that energy expenditure can be estimated in the critically ill patients by using Harris-Benedict, Kleiber, and Liu equations if the estimated stress factor is reasonable value (1.2).