胃癌病人围手术期静息能量消耗特点初步观察_医学论文.docVIP

胃癌病人围手术期静息能量消耗特点初步观察_医学论文 胃癌病人围手术期静息能量消耗特点初步观察_医学论文 【摘要】 目的 观察胃癌病人围手术期静息能量消耗特点。方法 随机选择胃癌病人46例为研究对象，以25例健康志愿者为对照组，应用间接测热仪测定对照组、胃癌病人术前及术后第1天的静息能量消耗，双能源X线吸收法测定病人人体组成，同时用简易营养评价法对胃癌病人行营养评价。结果 男性、女性胃癌病人术前静息能量消耗均较对照组降低（t=2.359、2.236，0.05）。病人静息能量消耗与瘦体含量呈明显正相关（r=0.602,0.01）。不同营养状态的男性胃癌病人其术前静息能量消耗有明显差异（F=6.493,0.01），而每千克瘦体的静息能量消耗无明显差异，术后静息能量消耗明显高于术前（t=2.496，0.05），术后呼吸商明显低于术前（t=2.415，0.05）。结论 胃癌病人术前静息能量消耗下降，下降程度与病人瘦体丢失密切相关，术后代谢支持应适当增加能量供应并调节各种营养物质的比例。 【关键词】 胃肿瘤；静息能量消耗；人体组成；营养评价 　　［ABSTRACT］ Objective To investigate the characteristics of rest energy expenditure （REE） of patients with gastric cancer during perioperative period. Methods Forty-six gastric cancer patients were enrolled randomly as study objects and 25 healthy volunteers served as controls. REE was measured by indirect calorimetry in the patients before and on day 1 after surgery and in the controls. Body composition was measured by dual-energy X-ray absorptiometry （DEXA） and nutrition was evaluated by mini-nutritional assessment （MNA）. Results REE in the patients of both sex was lower than that of the control （t=2.359, 2.2360.05）, the energy expenditure was positively correlated with lean body mass （LBM） （r=0.602,0.01）. There was a significant difference in preoperative REE among male patients with different nutritional status （F=6.493,0.01）, while no difference was found in REE/ LBM. Postoperative REE was higher （t=2.496,0.05）, and respiratory quotient was lower as opposed to before surgery （t=2.415,0.05）. Conclusion Before surgery, the REE decreases in gastric cancer patients, the extent of reduction is closely associated with the loss of LBM. Postoperatively, an appropriate energy supply is added and various nutrients are needed and the proportion be adjusted. 　　［KEY WORDS］Stomach neoplasms Resting energy expenditure Body composition Nutritional evaluation 能量代谢是指生物体内营养物质（主要指糖类、脂肪、蛋白质）在代谢过程中所伴随的能量产生和利用过程。静息能量消耗量（REE）即机体禁食2 h以上、平卧休息30 min后的能量消耗,约占总能量消耗的65%～70%。由于REE测定方便、实用,且能够较好地反映机体每天的总能量消耗,故为临床上研究人体代谢消耗的