【中级班】间接测热法营养评定用于评估左心室辅助装置植入患者
背景：已知营养不良不利于重度心衰的临床过程，与左心室辅助装置（LVAD）植入患者的死亡率增加有关。适当评定这些患者的营养需求对其临床诊疗至关重要，但如何最好地确定他们住院期间的静息能量消耗（REE）研究甚少。我们研究了间接测热法在一组重度心衰患者中的应用。
资料与方法：收集98例左心室辅助装置植入资格评估患者术前间接能量测定的结果。REE与10个预测公式进行比较，这些公式是根据一系列患者特定人口学特征和临床变量预测能量需求。
结果：本研究入组22例女性和76例男性患者，平均年龄59.4±12.5岁，体重指数29.6±6.0kg/m²，射血分数19.4±6.6%。该组患者间接测热法测得REE平均值为1610.0±612.7kcal/d。所有预测公式明显过高估计了REE。然而，那些用于重症的公式准确性最好，与Brandi公式的相关性最强（r=0.605，P＜0.001），并且估计值的标准差最低（504.8kcal/d）。
结论：间接测热法用于确定重度心衰患者的能量需求是可信、安全的。使用基于人口学特征和临床因素的预测公式预估这些患者REE不准确。然而，用于重症患者的公式比用于健康个体的公式能更好地估计营养需求。
Nutr Clin Pract. 2015;30(5):690-7.
Nutrition Assessment With Indirect Calorimetry in Patients Evaluated for Left Ventricular Assist Device Implantation.
Yost G, Gregory M, Bhat G.
Center for Heart Transplant and Assist Devices, Advocate Christ Medical Center, Oak Lawn, Illinois.
BACKGROUND: Malnutrition is known to negatively impact the clinical course of advanced heart failure and is associated with increased mortality following left ventricular assist device (LVAD) implantation. Appropriate assessment of nutrition requirements in these patients is critical in their clinical care, yet there has been little discussion on how to best determine resting energy expenditure (REE) in the hospital setting. We investigated the use of indirect calorimetry in a group of patients with advanced heart failure.
MATERIALS AND METHODS: Results from preoperative indirect calorimetry testing in 98 patients undergoing evaluation for LVAD candidacy were collected. REE was compared with 10 predictive equations that estimated caloric need based on a range of patient-specific demographic and clinical variables.
RESULTS: This study enrolled 22 female and 76 male patients with a mean age of 59.4 ± 12.5 years, body mass index of 29.6 ± 6.0 kg/m(2), and ejection fraction of 19.4 ± 6.6%. The average REE by indirect calorimetry in this group was 1610.0 ± 612.7 kcal/d. All predictive equations significantly overestimated REE. However, those equations intended for use in the critically ill demonstrated the greatest accuracy, with the Brandi equation achieving both the highest correlation (r = 0.605, P < .001) and the lowest standard error of the estimate (504.8 kcal/d).
CONCLUSIONS: Indirect calorimetry may be reliably and safely used to determine caloric requirements in patients with advanced heart failure. The use of predictive equations based on demographic and clinical parameters appears to generate inaccurate estimations of REE in these patients. However, equations designed for use in critically ill patients better estimate nutrition requirements than those designed for healthy individuals.
KEYWORDS: LVAD; calorimetry; heart diseases; heart failure; heart-assist devices; indirect calorimetry; left ventricular assist device; nutrition assessment
PMID: 26024679
DOI: 10.1177/0884533615588351