The Clinical Analysis On Energy Metabolism And Nutritional Support In Patients With Abdominal Surgical Diseases

The Clinical Analysis on Energy Metabolism and Nutritional Support in Patients with AbdominalSurgical DiseasesIn order to investigate the feature of energy metabolism and the clinical effect of nutritional support in patients with abdominal surgical diseases, 33 patients underwent surgical procedure were selected into this clinical trial. The series includes 15 males and 18 females, range 21~78 years old with mean age of 55.42+13.40. The nutritional support started postoperatively and lasted for more than 7 days. At postoperative day 1 and 7, REE was measured with Critical Care Management system (CCM), the other indexes including TSF, AMC, Alb, TRF, weight and subgroup of peripheral lymphocyte were also assayed simultaneously. At postoperative day 1, 3, 7, the urinary nitrogen was measured to determine the balances of Nitrogen.Results: 1. HBBEE were higher than the REE measured with CCM system by about 10%. 2. The weight after nutritional support with energy supply ranging from 0.4 REE to 1.3 REE was significantly lower than that of without nutrition support; there was no significance in TSF, AMC, TRJF, Alb, cellular immunity before and after the nutritional support. The amount of urinary nitrogen appeared a declining potency but not significantly while the supply of nitrogen was not changed. 3According to the amount of energy supply, the patients were divided into 2 subgroups: one received energy supply lower than 0.8 REE and the other received energy supply of 0.8-1.3 REE. In low-energy-supply group, the weight, TRF, TSF were significantly decreased after the nutritional support meanwhile no significant change of AMC, ALB, cellular immunity and urinary nitrogen were found. In the other group, there were no significant differences in weight, in contrast TSF, AMC, TRF, Alb, cellular immunity, urinary nitrogen were significantly lower after nutritional support.Conclusion: 1. The resting energy expenditure of the patient measured with CCM system is lower than that calculated with HB formula by about 10%. We should apply the metabolic cart to accurately measure the energy expenditure of patients to guide the clinical nutrition support protocol. 2. In this study, the significant decline of body weight indicates that the energy supply ranging from 0.4~1.3 REE cannot meet the energy requirement of patients underwent abdominal surgical operation. 3. The decrease of the other indexes and considerably low frequency of complications suggest that the energy supply lower than 0.8 REE in patients underwent abdominal surgical procedure may result in the exhausting of the body without influence the prognosis, in relatively short period of nutritional support. 4. The energy supply of about 1.0 REE can meet the energy requirement of the body. 5. The decreasing ofthe amount of urinary nitrogen means that the energy supply of about 1.0 REE can save the protein of the body.