背景:评估能量消耗对于建立营养治疗的最佳目标很重要。然而,间接量热法,测量能量消耗的参考标准,很难在临床实践中广泛应用。
目的:测试生物电阻抗分析(BIA)相对于间接量热法评估危重患者能量消耗的一致性。
方法:对140名危重成人患者进行横断面研究。在病人被转移到重症监护室的24小时内,训练有素的研究人员通过同时使用BIA和间接量热法评估患者的能量消耗。通过具有双向随机效应模型的组内相关系数检测2个测量值的一致性。分析了影响一致性的因素。
结果:通过间接量热法测量的能量消耗中位数为1430.0kcal/d(IQR,1190.5-1650.8千卡/天)。BIA测得的中值能量消耗为1407.0千卡/天(IQR,1248.5-1563.5千卡/天)。间接量热法与BIA的相关系数为0.813(95%CI,0.748~0.862;P<.001)。有合并症的患者的2项测量结果的一致性低于没有合并症的患者(P=.004)。
结论:BIA的结果与危重患者能量消耗的间接量热法评估高度一致。在评估能量消耗时,除了合并症外,几乎没有其他因素会影响BIA的准确性。因此,作为一个低成本的,易于使用,和非侵入性方法,BIA是评估危重患者能量消耗的有价值的临床工具。
BACKGROUND: Evaluating energy expenditure is important for establishing optimal goals for nutrition treatment. However, indirect calorimetry, the reference standard for measuring energy expenditure, is difficult to apply widely in clinical practice.
OBJECTIVE: To test the consistency of bioelectrical impedance analysis (BIA) relative to indirect calorimetry for evaluating energy expenditure in critically ill patients.
METHODS: A cross-sectional study of 140 critically ill adult patients was conducted. Within 24 hours of a patient being transferred to the intensive care unit, trained researchers assessed the patient\'s energy expenditure by use of BIA and indirect calorimetry simultaneously. Consistency of the 2 measurements was detected by intraclass correlation coefficients with a 2-way random-effects model. Factors affecting consistency were analyzed.
RESULTS: Median energy expenditure measured by indirect calorimetry was 1430.0 kcal/d (IQR, 1190.5-1650.8 kcal/d). Median energy expenditure measured by BIA was 1407.0 kcal/d (IQR, 1248.5-1563.5 kcal/d). The correlation coefficient between indirect calorimetry and BIA was 0.813 (95% CI, 0.748-0.862; P < .001). The consistency of the 2 measurements was lower in patients with comorbidities than in those without (P = .004).
CONCLUSIONS: Results of BIA were highly consistent with indirect calorimetry assessments of energy expenditure in critically ill patients. Few factors except comorbidity affect the accuracy of BIA when assessing energy expenditure. Therefore, as a low-cost, easy-to-use, and noninvasive method, BIA is a valuable clinical tool for assessing energy expenditure in critically ill patients.