【摘要】 目的：验证间接测热法（IC）与新型预测公式测定老年重症病人静息能量代谢值的一致性，为这种新型基于APACHE II评分的能量代谢预测公式应用于临床提供依据。方法：观察对象为南华大学衡阳医学院附属第二医院重症医学科2020年1月至2020年7月期间诊治的102名老年重症病人。笔者前期研究的新型预测公式REE=(1.003+APACHE II×0.016)×HB，其经由一元回归对同APACHE II评分有关的HB法应激系数进行拟合所得。使用IC法测量病人入ICU后第1、3、5、7天的全天静息能量代谢值，将入ICU后第1天IC法测量值作为“金标准”与新型预测公式计算值进行对比，两种测量方式用Bland-Altman法进行一致性评价；将28 d预后、是否发生院内感染作为结局预测指标，两种方法的预测价值采用受试者工作特征曲线（ROC曲线）检验其是否存在差异。结果：IC法测定的入ICU后第1、3、5、7天的全天静息能量代谢值[(1 781.5±261.2) kcal/d、(1 728.8±260.8) kcal/d、(1 824.5±265.6) kcal/d、(1 749.1±267.4) kcal/d,F=2.459,P=0.062]，差异无统计学意义，提示病人入ICU后1周内能量代谢值无较大波动。将IC法测量值与新型预测公式计算值进行比较[(1 781.5±261.2) kcal/d vs (1 801.1±218.5) kcal/d]，差异无统计学意义（P> 0.05）;Bland-Altman分析显示，两种方法一致性较好；ROC曲线分析结果显示两种方法对28天预后及院感的预测价值基本一致（P> 0.05）差异无统计学意义。结论：间接测热法（IC）与新型预测公式测定的静息能量代谢值一致性较高，可以使用该方法预测老年重症病人静息能量代谢的目标值。更多还原

【Abstract】 Objective: To verify the consistency of a novel prediction formula with indirect calorimetry(IC) for the determination of resting energy expenditure in elderly critically ill patients, and to provide a basis for the clinical application of this novel prediction formula based on the APACHE II score. Methods: The subjects were 102 elderly critically ill patients admitted to Department of Critical Care Medicine, Second Hospital of South China University between January 2020 and July 2020. The novel prediction formula: REE =(1.003+APACHE II×0.016) × HB, which was obtained by fitting the HB method stress coefficient related to the APACHE II score by one-dimensional regression.The IC method was used to measure the resting energy expenditure of patients on days 1, 3, 5, 7 after ICU admission,and the IC method values on day 1 were used as the "gold standard" for comparison with the values calculated by the new prediction formula. The prognosis at 28 days and the incidence of nosocomial infection were used as predictors of outcome, and the predictive value of the two methods was examined by using the receiver operating characteristic curve(ROC curve) Results: The differences in the resting energy expenditure values [(1 781.5 ± 261.2) kcal/d,(1 728.8 ±260.8) kcal/d,(1 824.5 ± 265.6) kcal/d,(1 749.1 ± 267.4) kcal/d, F = 2.459, P = 0.062] measured by the IC method for1,3, 5, 7 days after ICU admission were not statistically significant, suggesting that there were no major fluctuations in energy expenditure values during the week after ICU admission. Comparing the measured values of IC method with the calculated values of the new prediction formula [(1 781.5 ± 261.2) kcal/d vs(1 801.1 ± 218.5) kcal/d], the difference was not statistically significant(P > 0.05); Bland-Altman analysis showed that the two methods were in good agreement; the results of ROC curve analysis showed that the predictive value of the two methods for 28-day prognosis and nosocomial infection were comparable. Conclusion: There is consistency between the indirect calorimetry(IC) method and the novel prediction formula in examining resting energy expenditure, and the novel method can be used to predict the target values of resting energy expenditure in elderly critically ill patients.更多还原