Increased Resting Energy Expenditure after Endovascular Coiling for Subarachnoid Hemorrhage
Increased Resting Energy Expenditure after Endovascular Coiling for Subarachnoid Hemorrhage
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DOI：
10.1016/j.jstrokecerebrovasdis.2015.12.008
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发表时间：
2016-04-01
影响因子：
2.5
通讯作者：
Koyama, Tetsuo
中科院分区：
文献类型：
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作者：
Nagano, Ayano;Yamada, Yoshitaka;Koyama, Tetsuo
背景：对于蛛网膜下腔出血(SAH)患者来说，从急性期开始进行适当的营养护理是改善功能预后和降低死亡率的关键。尽管血管内弹簧圈越来越多地被用作神经外科夹闭和开颅手术治疗破裂动脉瘤的替代方法，但这种新技术治疗的患者的静息能量消耗(REE)还没有得到系统的评估。方法：采用间接量热法测定12例蛛网膜下腔出血患者血管内线圈治疗前后的稀土元素含量。取血管内栓塞后第1天和第7天的REE平均值，并与30例急性脑梗塞(ACI)患者进行统计学比较(P<；0.05)。接下来，我们计算测量的稀土元素值与使用哈里斯-本尼迪克特方程估计的值的比率，以调整两组之间在性别、体重、身高和年龄方面的人口统计学差异。结果：SAH患者的这一比例(中位数1.12；四分位数范围1.05-1.23)显著高于ACI患者(中位数1.02；四分位数范围0.97-1.09)。结论：由于血管内缠绕比神经外科手术创伤小，观察到的REE增加归因于SAH后的代谢变化。为了从急性期向SAH患者提供最佳的营养护理，临床医生应该意识到REE的这种变化。
Background: Appropriate nutritional care from the acute stage is essential for improved functional outcomes and reduced mortality in patients with subarachnoid hemorrhage (SAH). Although endovascular coiling is increasingly being used as an alternative to neurosurgical clipping and craniotomy for ruptured aneurysms, the resting energy expenditure (REE) of patients treated with this new technique has not been systemically evaluated. Methods: We measured REE values by indirect calorimetry in 12 SAH patients treated with endovascular coiling. We averaged the REE measurements obtained on days 1 and 7 after endovascular coiling, and then we statistically compared the mean REE values with those in 30 patients with acute cerebral infarction (ACI) by the Wilcoxon rank-sum test (P < .05). Next, we calculated the ratio of measured REE values to the values estimated using the Harris-Benedict equation to adjust for demographic differences in sex, weight, height, and age between the groups. Results: The ratios were significantly higher in SAH patients (median value, 1.12; interquartile range, 1.05-1.23) than in ACI patients (median value, 1.02; interquartile range,.97-1.09). Conclusions: Because endovascular coiling is less invasive than neurosurgical clipping, the observed increase in REE was attributed to metabolic changes after SAH. To provide optimal nutritional care to SAH patients from the acute stage, clinicians should be aware of this change in REE.